Hi all. Timm's wife again. So we met with rad oncologist & they recommended radiation only, no chemo, for 6 weeks. My question is on dosage & side effects differences between receiving 60gy & receiving 70+gy??? Been devouring board but haven't been able to come up with anything yet (user error I am sure). Anyway, I know everyone is different & reacts differently, but if anyone can shed more light on this, that would be great. Also, all his post surgery results were very good (c signature below...i tried to update it).

Thanks once again!!

That is one option with for T1N2a with the surgery you had, with no adverse findings. not even with radiation, according NCCN guideline, and have other treatments as well at this stage, could have been restaged surgery. and have mixed thoughts on treatments.

I had similar but T1N2bM0 tonsil, PET showed uptake in BOT, Valleculla, but none on biopsy, except none on biopsy. My treatment plan was Induction chemo, 3 cycles for 5 days, and then chrmoradiation later on. I just did 5 days chemo, and stopped treatments due to severe toxicities for over a year. Chemo alone does not cure cancer, only radiation, surgery does, chemo is used as a radio sensitizer to make radiation sensitizer, 2-20 percent or more, decoding on chemo. Studies show Chemoradiation has better outcome, but added toxicities.

HPV positive responds well to radiation, even bettter with Chemoradiation, and there is talk of desculation, but in clinical trials only, and most info out there is non HPV. BOT can be difficult to treat, due to the deep musculature, and rich in lymphatics, that can harbor, spread disease. I guess something showed on a scan for the clinical diagnosis, but ND, shows no cancer. Usually the the metasteses is to level ll in the oropharynx, but there can be skip metastases or microscopic cancer, and can even be missed in the biopsy pathology. There are over 300 lymphs in the cervical neck, mostly microscopic, and amount is different in location, amount in each person. Even in a ND, they probably did not get them all.

I'm very unique, but I had 5 recurrences, several types of treatment. I had a three neck dissections, two which resulted in recurrences, even though I had clear PET scans, I had radiation alone, 70Gy, and clear scan, but still had a recurrence. Reason alone was due to the MO or RO not wanted to it. More than 50Gy is needed to kill SCC, and usual dosage is 66-70Gy with IMRT, lymph nodes around 62Gy, lesser sometimes. After my 5th recurrence, I was well enough to do agressve treatment, which window of opportunity may not be there again my local doctor said.

I hope this helps.

I received a dose of 60gy to the left neck lymph nodes, probably 50-60gy to the right neck, and 70gy to the primary (left tonsil and base of tongue). I was part of a clinical trial on dose deescalation based on a lack of hypoxia in the tumor.

My RO stated that with a lower dose of radiation I would have a less chance or severity of trismus, xerostomia, and risk of late onset effects such as osteoradionecrosis among other effects. I dont believe the difference between 60gy and 70gy has been quantified yet with respect to quality of life.

My RO told me that some docs do 60gy on the neck with a neck dissection as standard of care. She usually does 70gy on the neck, but without a neck dissection. I'd ask if the 60gy is to the neck or to the primary as well. My doc was not comfortable deescalating the dosage to the primary cancer location as part of her clinical trial for any patients.

This is a discussion you should have w/ your RO. I don't believe there are any finished studies comparing 60 to 70 gys. I'm not even sure there is an applicable ongoing study. As Andrew stated above not all areas on the throat and neck are always subjected to the same level of rad during the treatment. In my case the rad machine stopped in 6 different areas on my neck at first and by the time I had my last rad session it only stopped at 3 places. My RO would tell me when I was finished with one area but I never knew enough waaaayyyy back then to ask why.