Just a quick addition to this thread --- when we consulted at Sloan, we were specifically told that they do not do surgery first, and in fact, try to avoid it after chemo/rad except where absolutely necessary. Now this was in relation to an advanced HNC -- I assume that someone presenting with a stage I or II which can be addressed by a localized surgical procedure would be handled differently. They also said Anderson did things the same way.

At Hopkins, we got the very strong impression that surgery first is only favored by some of the surgeons (which would be expected) and then not for cancers involving the base of tongue or areas where there would be serious QOL complications. Our med onc said that surgery is "controversial" within the HNC group because of these QOL issues.

It does appear that approaches are evolving and probably when some of the new, more targeted drugs hit the streets they will change even more. This follows the pattern of other cancer treatments, e.g. breast cancer...

Gail Mackiernan