.In reading through the many posts, it seems tongue surgery was done, and due to the close margins, and lymphovascular invasion, LVI, a neck dissection was done with no further cancer found. Different consultations resulted in a number of further treatment options because of the negative prognostic factors found after tongue surgery, and is where brachytherapy came in, which is good for close or positive margins, PNI, perineural Invasion, and LVI.

At this same point, I've had similar findings, but with positive margins, and lymphovadcular invasion, LVI, and one with both LVI and PNI.

My treatment (s) were: 1. Neck Dissection to remove remaining cancer, 2. High-Dose Intraoperative Radiation Therapy, HD-IORT during surgery directly on the tumor bed (similar to brachtherapy) and 3. A pec flap to do additional radiation, and 4. 4-6 weeks after healing, additional IMRT or Proton Therapy with chemo, (Chemoradiation).

As you can see, my doctors incorporated everything or smilarly suggested for your brother, to deal with my persistent cancer. My scan was clear after my treatment in May.

As far as PNI and LVI, it's not cut and dry as far as its definate invasive spreading, but my doctors took no chances. They said without further Proton treatment (external beam radiation), Chemo, I stood a 70% chance of my cancer returning.

Each person, cancer, doctor, treatment, and outcome is different.

I hope this helps.