Another update - and Decision Time.

Hi everyone. I met today with the RO. He predicted equal chances of success with surgery followed by radiation, or a combination of radiation and chemotherapy (cisplatin). For the post-surgery follow-up he would administer 60 "units", OR 70 without surgery first.

The RO is worried about the possibility (from the CT scan) that cancer cells may have escaped one of the infected lymph nodes. In that case he would add cisplatin to the radiation follow-up. For that reason I think he favors just going with radiation and chemo (to avoid having to use all 3 forms of treatment and suffer the side effects of all of them). But the only way to know if chemo will be required though is to have surgery and get the pathology report. So with surgery there are 2 certain and 3 possible treatments, and with RAD there are just the two.

I still feel like TORS surgery is the best way to go, and we decided on that during the consult. In the event that there have been escaped cells, they�ll do the cisplatin at a relatively low dose (40mg) 1x/week for the entire 6 week radiation treatment. This seems to be the advice from others here in the forums who've had it both "big bag" and metered out more gradually - at least in terms of side effects.

Radiation To set up for this will take about 4 to 6 weeks after surgery, including a week to plan the precise treatment plan. I am figuring that surgery will happen sometime between April 13 and April 24, this would put the start of RAD in late May, with completion around end of June or first week of July.

My RO is a fan of the PEG tube insertion, particularly if we have to involve chemo (he says the last 2 weeks of RAD are pretty rough and very hard to get things down). My surgeon is not so much a fan, because he thinks there are better swallowing outcomes if patients are forced to do that during treatment. I guess I�ll leave the PEG decision until after surgery when we get the pathology report. I�m inclined to forego the tube unless chemo is involved.

On the mental side, the more I learn the better I feel. Part of that is that every doc I�ve seen so far has used the word �cure�. The surgeon said 90%, and the RO said 80% today. Why not me then? And the more I learn, the more confidence I have that although it won�t be pretty, I can do this. It is sure going to be an interesting summer.

So -- what are your reactions to above, particularly with respect to the surgery/RAD approach, use of PEG, and what to expect with side effect symptoms, durations, and long term prospects? I have read a *lot* of this already on the site. Guess I'm just looking for a little reassurance. And thanks.