That is one option with for T1N2a with the surgery you had, with no adverse findings. not even with radiation, according NCCN guideline, and have other treatments as well at this stage, could have been restaged surgery. and have mixed thoughts on treatments.

I had similar but T1N2bM0 tonsil, PET showed uptake in BOT, Valleculla, but none on biopsy, except none on biopsy. My treatment plan was Induction chemo, 3 cycles for 5 days, and then chrmoradiation later on. I just did 5 days chemo, and stopped treatments due to severe toxicities for over a year. Chemo alone does not cure cancer, only radiation, surgery does, chemo is used as a radio sensitizer to make radiation sensitizer, 2-20 percent or more, decoding on chemo. Studies show Chemoradiation has better outcome, but added toxicities.

HPV positive responds well to radiation, even bettter with Chemoradiation, and there is talk of desculation, but in clinical trials only, and most info out there is non HPV. BOT can be difficult to treat, due to the deep musculature, and rich in lymphatics, that can harbor, spread disease. I guess something showed on a scan for the clinical diagnosis, but ND, shows no cancer. Usually the the metasteses is to level ll in the oropharynx, but there can be skip metastases or microscopic cancer, and can even be missed in the biopsy pathology. There are over 300 lymphs in the cervical neck, mostly microscopic, and amount is different in location, amount in each person. Even in a ND, they probably did not get them all.

I'm very unique, but I had 5 recurrences, several types of treatment. I had a three neck dissections, two which resulted in recurrences, even though I had clear PET scans, I had radiation alone, 70Gy, and clear scan, but still had a recurrence. Reason alone was due to the MO or RO not wanted to it. More than 50Gy is needed to kill SCC, and usual dosage is 66-70Gy with IMRT, lymph nodes around 62Gy, lesser sometimes. After my 5th recurrence, I was well enough to do agressve treatment, which window of opportunity may not be there again my local doctor said.

I hope this helps.