Both ENT Doc's I have been to recommend surgery immediatley before any chemo is done. I have read where chemo can be done first to shrink the tumor (mine is stage 4 tumor on left side of tongue) possibly saving more of the tongue. I have been told the tumor has really grown too large for chemo to help and I would like to hear if others have gone different ways on which they did first. I should mention the tumor is bad enough I can hardly speak and don't want to eat so I don't have much time to mess around with this thing. My reconstruction ENT has done hundreds of these with good success so I feel pretty confident I'm getting back about the most I can as far as speech and eating go.