Hi Minniea --

I think your question was really for me (not Amy) as her husband is not at the decision stage yet for a ND.

My comments referred to ND in general, at least this is the impression our MO brought back from the ASCO meetings this past summer, where benefits from ND was apparently a "hot topic." She said ND is falling out of favor (that's a quote) because more serious side effects are being seen with no significant benefit -- e.g. paper from Fox Chase showing doubling of time on a feeding tube in ND patients. Certainly some top CCCs (e.g. Sloan-Kettering, ranked #1) no longer routinely do ND.

As many of you may have read, my husband did not have a neck dissection as none of his doctors save the Hopkins ENT recommended it -- and now even he agrees Barry made the right decision, for him.

However, Barry did have a pre-treatment radical tonsillectomy by another ENT, which was when his cancer was diagnosed. The tonsillar cancer was his primary though he also had nodal involvement and base of tongue. As with many (most?) non-smokers with tonsillar/BOT cancer his was strongly human papilloma virus positive.

The latter is an important point. There is a great deal of ongoing research on HPV+ cancer now and they are finding far less recurrence, better response to treatment, and better long-term survival in HPV+ SCC. Barry was entering the Hopkins HPV vaccine trial and of course well up-to-date on this information. This undoubtedly played a role in his decision to decline ND (and it was always his decison). Since he had an apparent successful respose to treatment, the doctors did not try to compel him into surgery, though I am sure if his post-treatment scans had indicated failure of treatment the consensus recommendation from his "team" would have been quite different.

A number of papers have shown little benefit overall for ND but some have indicated that a subset of patients show improved locoregional control (about 5-10% per both our ENT and RO). Our RO added, but no long-term survival advantage. Other papers have shown improved survival in patients with residual nodal disease, as indicated by post-treatment scans or exams.

One problem, and this is highlighted in Dr. Gillison's editorial in Dec. 2006 Journal of Cinical Oncology, is that many studies comparing treatment protocols do not know HPV status of the patients or do not restrict the experimental groups to one type or another. This can greatly "muddy" the results, since the two cancers are biologially different and could respond differently to treatment, possibly even including benefits of neck dissection.

So right now this appears to be a changing scenario, which makes it dificult for patient to make a decision.

Gail