Although its late in the game for questions-everything happened too fast to question before-I still am confused about my treatment. After having stage 1 scc on tongue return 2 months after surgery with clear margins and pop up in 1 node, I had radical neck dis. and started IMRT radiation. I only have 2 treatments to go. They are radiating both sides of neck and tongue. When I asked about tongue they said they were radiating the whole thing. Everything I read about IMRT sounds like its more of a focused type treatment. I don't have a tumor to "focus" on. Was removed with surgery. Can IMRT really cover my whole tongue. I've been in a fog during this whole ordeal due to sickness from amiphostine and pain meds. I'm doing great now but all these questions and concerns are overflowing my head. So I guess these are my questions:
1. Can IMRT radiation be more broad and not focused?
2. Does anyone know any facts that might reassure me about this not returning? (reoccurance in tongue, removed with clear margins, right mod. rad. neck disection with one node involved, 33 rad treatments) sorry so long

KimRuth,

I assume they can radiate the whole tongue with IMRT because I was told that's what they did with me too. I have some of the same concerns about that you do, since there was nothing to focus on in my case--I didn't have any nodes with cancer and my tumor was removed with clear margins before the radiation. Also they enver gave me anything to hold my tongue in exactly the same spot--which now worries me too-though I tried to keep it in the same place as much as I could eb aware of where it was.

Anyway I was told they radiated the entire tongue and the lymph pathways on both sides of the neck.

I totally understand about being so groggy and sick that you don't think of these quesitons until afterwards--in my case it was months afterwards! I wish I could help you with info. or facts that might reassure you but I haven't read much of anything about recurrences.

Nelie

Hello KimRuth, Yes they can and do radiate larger areas with IMRT. Essentially they map out areas to provide better control of side effects (such as salivary glands).

As far as reassuring facts go you can search here at the forum about "statistics" and you will read plenty. My sugestion: don't bother! Have hope, live each day, trust your care givers (or find new ones. Radiation can be very effective.

You are alive today, that is all anyone ever knows for sure.

Here is the controverial thought for the day:
If you had not been diagnosed or treated until the node popped up you would perhaps been staged differently but not have been in the "recurrent" catagory. Recurrent cancer usually will be statistically classed with a group that has a poorer outcome. I do not think that is good use of statistics. In other words You may do much better than your statistical class/group. Staging and statistics are for doctors. Try not to dwell on it.

I had the same thought as Mark. If they had done a neck dissection on you originally, they probably would have found cancer in that node then and it wouldn't be a recurrence but just a different stage. That's definitely the way I would think about it if I were you because this isn't like other forms of recurrence where something comes back in a spot already radiated or operated on (which do tend to have poorer outcomes).

It's not completely true that they had "nothing to focus on". Although they didn't have an obvious tumor, they do know the usual "cast of characters" where nodes can be involved and other areas that can cause problems later on. Remember that tumors under 2mm are undetectable by current scanning modalities. It is more of a prophylaxsis type of treatment. Considering the aggressiveness of tongue cancers in gerneral I personally would sleep better at night knowing that they are hitting this as hard as possible. I wouldn't call it a recurrence either, rather a part and parcel of the original cancer (I agree with Mark's opinion).

To answer your original question, they can shape IMRT to any shape they please but the main idea is to avoid unnecessary tissue damage and improve quality of life afterwards. Most of the time Amofostine is unnecessary as IMRT will typically spare the salivary glands unless your treatment protocol puts all of them directly in the radiation field.

I don't believe that neck disections are done for stage one patients as a general rule (surgical resection being preferred) but there are exceptions. See http://www.nccn.org/professionals/physician_gls/PDF/head-and-neck.pdf for more information.

KimRuth,

There are basically two types of radiation treatments used for head and neck with the exception of brain tumors.

The older type which is still widely used is called external beam radiation. The new type is IMRT which stands for Intensity Modulated Radiation Therapy. IMRT is an advanced high precison therapy which can deliver higher radiation doses to the tumor or specific target areas and minimize irradiation of surrounding healthy tissues in order to reduce or possibly avoid post radiation treatment side effects.

IMRT is used in conjunction with 3-dimensional computed tomography of the patient or in essence CT scans to deliver doses to precisely the intented areas.

As it has been said in previous posts, yours most likely is not a recurrence but continued growth of cancer cells left behind following the initial surgery.

Like Mark previously said please do not worry about statistics because everyone is different. Plus statistics tend to aggregate a lot of different people with different conditions in one group and the relevance of that statistics to a particular individual may be misleading.

KimRuth,

Just to add to Gary's comments, I think whether or not lymph nodes are removed for a Stage I tumor varies from doctor to doctor. The ENT who did my initial surgery and tumor removal did not do a neck dissection to remove lymph nodes and said that there was no need to.

Brian has repeatedly noted that there is micro or occult mets in about 30% of Stage I diagnoses which, in part, is why I sought a second opinion in Boston.

The ENT in Boston who is monitoring me now said that he always does a neck dissection for Stage I and removes 1-3 of the closest nodes. This, he said, enables him to biopsy the nodal tissue and either confirm that there is no micro mets or not. If there is, then he knows that he has to remove more nodes and can also better gauge how aggressive treatment regimen should be.

Also, your original question asked about IMRT and the lack of a target. Often the target will be the tumor bed and the closest nodes to the tumor location. Using IMRT can increase the precision with which any area can be targeted and will also spare adjacent tissue. - Sheldon

Thank you so much for all the information. Lots of love to everyone out there. Kim

Hi Kim. It sounds like you and i have very similar cancer. I had a size 1-2 cm tumor on my tongue. I was told it was very unlikely that it would have spread to my neck, but I had a neck dissection, and guess what! There was one positive node. I agree with Nelie, that it probably was not "recurrance", but disease that might have been found if you had a neck dissection earlier. I guess you'll never really know.
Anyway, I am getting "one sided" IMRT, but my doctor said that really over 2/3 of my tongue is getting radiation. So I don't think they focus just on the tumor area. From my understanding, the best thing about the new IMRT is that it can spare your salivary glands a little more than the old fashioned XRT.
Good luck to you, are you almost done? I have 10 more treatments left. God Bless you for being on amiphostene - I had to quit after the first. That stuff is terrible! Hang in there - you are doing the right thing to get aggressive treatment. In the end, I think we will be glad we went through this. Best Wishes, Laura G