1 Introduction Treatment for early-stage oral tongue squamous cell carcinoma (OTSCC), i.e., T1-T2N0, is typically surgical resection, with consideration of upfront elective neck dissection (END). Adjuvant radiation is recommended if there are adverse pathologic features, such as close margins, perineural invasion (PNI), lymphovascular invasion (LVI), or metastatic lymph nodes [1].