Hi everyone.
I have a question as it relates to treamtment of stage IV SCC base of tongue with bilateral neck metastasis. I have read many postings where patients who have had radiation and chemo, that had a palpable mass on the neck undergo selective neck dissection. My husband finished radiation and chemo in June and he still has a palpable mass on the left neck. The ENT is sure that it is dead tissue. His recent laryngoscopy showed no signs of cancer in the mouth. He took some tissue from the neck with a needle biopsy and sent it to the lab, and said that he would see him again in October. I questioned as to why removal of the tissue was not being done and was told that the goal of radiation and chemo was to prevent the need for surgery and the surgery may do him more harm than good. Just wanted the forums thoughts on this. I am not trying to second guess the doctor but just want as much informative info as possible. He is being treated at U of Michigan which is an excellent comprehensive care center. Any info would be greatly appreciated.
Sincerely,
Virginia Beck

Virginia, This must be another issue where the treatment varies widely among various treatment centers. My husband had a small primary SCC BOT tumor and one swollen lymph node when he was first diagnosed. His CCC, Moffitt Cancer Center, decided to do surgery first and then radiation. They had planned to do a selective neck dissection which became a modified radical neck dissection during surgery when they found that four lymph nodes had cancer and the cancer was also affecting a nerve and muscle. He had 15 lymph nodes removed and definitely has had lasting effects such as shoulder weakness and pain since they cut into nerve endings. PT, and now exercise, seems to continue to improve this, but he was told it would probably take a year to heal fully.

Everyone's situation is different but then the treatments across cancer centers seem to be different even for similiar cases from what I've read on this forum. I suppose you would have to be familiar enough with H&N studies to analyze the mortality and QOL outcomes to come to your own conclusion.

I have the complete document for one of the few studies benchmarking treatment outcomes of head-and-neck cancers with use of IMRT treatment. According to this study, "combined surgery and postoperative IMRT produced improved locoregional control and DFS compared with definitive IMRT (IMRT alone). This was in part a result of patient selection, because operable lesions tend to be smaller and have favorable features". This particular study also found no "statistical significance between IMRT alone and the patients treated with radiochemotherapy". However, it notes that three other meta-analyses showed that concomitant administration of radiation therapy and chemotherapy led to an absolute benefit on 5-year survival rate of about 10%.

I think the decision for surgery or not usually depends a lot on tumor volume and other factors. But as I said, different centers seem to have different approaches to the same situation as well.

Best wishes to you both. Connie

Hi Virginia,
Just want to share with you my own experience. I had concurrent chemo and radiation treatment for my T2N3M0 tonsil cancer. Surgery was originally planned after the treatment but in the follow up tests, about 6 weeks post treatment, cancer cells were not detected in both the tonsil and the neck lymph nodes. And so I did not undergo any surgery. I remember that my neck was still swollen and I also wondered if the tumor was still active. My oncologist assured me that it was just dead tissue and said that the area would be under very close observation. The swollen part gradually disappeared and I look 100% the same as before. I have been in remission for almost 4 years already. I understand your concern and please bear in mind that every case is unique but it is always good to know more.

Karen

Dear Connie and Karen,
Thank you so much for the information. I feel better knowing that it has been four years for you Karen and you did not have any surgery as well. My husband was diagnosed as T4N2cM0 base of tongue cancer but had bilateral lymph node involvement. He looks good, except alot thinner, and went back to work 3 weeks after treatment. I am grateful for the info. Thanks again,
Sincerely,
Virginia