In what scenario, if any, would you treat a unilateral neck (vs. bilateral neck) for post-operative oral cavity (in historically midline structures such as oral tongue, FOM etc) SCC patients?  

For midline oral cavity structures I always treat bilateral necks. This is true even for well lateralized oral tongue cancers. There is a very rich lymphatic network for oral tongue and floor of mouth and involvement of level 4 while skipping levels 1-3 on the ipsilateral side as well as contralater...

RTOG protocols treat the bilateral neck, even with well lateralized lesions of the oral tongue, and many would cover the entire tongue, not just the primary tumor bed with margin. Just wanted to point out that there is some evidence supporting unilateral neck radiation in this situation. In select...

Has the neck been addressed surgically? As a purist, I agree with above, i.e., would treat bilateral neck for OC midline tumors.  However, the recently published long-term results of a Phase II study from WashU that looked at eliminating PORT in *pN0* neck did give me pause...