Hi New Yorker,
It sounds like chemo or
Erbitux (or even both) are a likely addition. The medical oncologist is the one responsible for prescribing chemo or
Erbitux, or they are at least consulted as part of a multidisciplinary team. Rt is a definite requirement for nodal involvement like that. Be clear that Rt is the one that tends to have the most side effects; chemo is just the word that scares people off the most. Chemo enhances the side effects AND effectiveness of Rt; so does
Erbitux but in a different (and usually milder but not less effective) way. I must stress that I am new to this, not a doctor, and have been up for to days.
I cannot post links, but I can post a discussion on this very topic you brought up that I had on another forum last night for mouth cancer. It was answered by an oral cancer specialist and founder of the site as a matter of fact. Nice and smart guy (as is Brian Hill!!!). I'll post the texts below:
My post: "Papa needs Radiation therapy but it is our choice whether to go with
Erbitux or Cisplatin so this is what I am trying to decide ASAP. I am looking for studies about
Erbitux effectiveness both when used +rt and +rt+chemo compared with rt+chemo alone. If you know of any please send the link.
Quick pathology overview: Staging is T2N2M0. Papa's pathology indicated 8mm deep tumor during partial glossectomy and clear margins with 2/33 nodes showing small involvement and perinodal extension in level II. The doctor said that we wouldn't be combining
Erbitux with cisplatin because Indians seems to be less tolerant to aggressive treatments than those euoropean and american patients who are used in the studies on which
Erbitux related treatments are based. But he recommended
Erbitux over cisplatin.If we do go with
Erbitux we might have to pay for it. Is it an added benefit that is worth the added cost? "
Dr vinod joshi's post:
Hello Tasha
Positive points to show it helps improve the odds:
EXTREME, a randomised clinical trial examining the effect of first-line combination of cetuximab plus cisplatin or carboplatin and 5-fluorouracil compared to cisplatin or carboplatin and 5-fluorouracil in patients with recurrent of metastatic SCCHN has now completed.
It shows an improved result with Cetuximab which does not currently have a UK marketing authorisation for the treatment of metastatic and/or recurrent SCCHN. However, NICE is now in the process of appraising this.
Cetuximab in combination with radiation therapy is currently indicated for the treatment of patients with locally advanced SSCHN but because the evidence that it is better than platinum based chemotherapy was not available the last NICE Technology Appraisal on cetuximab (No. 145) could only recommend cetuximab in combination with radiotherapy as a treatment option only for patients with locally advanced squamous cell cancer of the head and neck whose Karnofsky performance-status score is 90% or greater (meaning in good health as it works best in healthy patients) and for whom all forms of platinum-based chemoradiotherapy treatment are contraindicated (for patients who could not tolerate the side-effects of platinum chemo.)
The oncologists I asked, said they would use cetuximab for themselves! While cetuximab has side-effects too, platinum is worse according to patients. Since cetuximab inhibits the proliferation of cells dependent on EGFR activation for growth, it may be worth to check that the cancer cells genotype for susceptibility. Ask your oncologist for advise. There is no clear right answer as most oncologists have most evidence for the platinum chemos.
Hope that helps!
Best wishes
Vinod
Disclaimer: Please see your own dentist/doctor for a proper diagnosis as my words should not, in any circumstances, be taken as dental/medical advice.