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Combined modality therapy with surgery followed by appropriate adjuvant treatment with radiation therapy with or without concurrent chemotherapy based on risk factors is the standard of care for locally advanced cancers. However, in early cancers with unfavorable features, treatment policies vary across different centers, with decisions often based upon the treating oncologist's clinical discretion and institutional practice. In this review article, we intend to discuss the existing literature on the role of adjuvant treatment intensification in early node-negative and single node-positive oral cavity cancers.