Hi!

My mother has had a history of recurrent oral cancer over the past few years. She has had several surgeries in her mouth on one side. Not long time ago, she discovered swelling under her jaw - turned out she had positive lymph nodes. She had a surgery to remove all of her lymph nodes on that side.

The final pathology report showed 2 positive lymph nodes out of 7 on Level 1. All Level II, III and IV nodes were benign. "Extranodal extension" was identified. According to our doctor, that meant higher chances of recurrence, and that my mother definitely needs radiation. When I asked about any other treatments that may help her chances of recovery, he thought about for a minute it and said that additional chemotherapy may help to referred us to chemotherapist and radiation therapist.

Obviously, my mother is very concerned about the side effects. Since doctor did not originally mention chemo, we are wondering whether it is really necessary to add chemo to radiation and whether it will really provide additional help in her case. Also, he mentioned that Erbitux has milder side effects than Cisplatin.

We have scheduled appointments with Head & Neck Oncologist (chemo specialist) and Radiation Oncologist in 2 weeks (the earliest they could do). Wanted to know if folks here have any thoughts about this diagnosis and about these forms of treatment and can share any insights on that.

Thanks

Hello N Y,

Welcome to OCF. I am sorry to hear that your mom is going through this.
I can only say for my self that I was told that the chemo and radiation were necessary to help prevent it from spreading.

I started with stage one & had part of tongue removed. No chemo and radiation at that time. Then year later had lymph node in neck infected stage 4. That is when they did the neck surgery, followed by radiation and chemo. I am now 2 1/2 years cancer free. I am check by a head and neck specialist every six months.

As far as which is better Erbitux VS Cisplatin. I do not really know. I had the Cisplatin. I am sure some one here may be able to answer that question.

Take care,:)
Diane

Hi NewYorker,

I just finished treatment for a Stage IV tumor on my tongue and had both cisplatin and Erbitux. When given in weekly doses, the side effects of cisplatin are not so bad and the biggest problem with Erbitux has been with my skin (acne-like rash and cracking on my fingers and feet). What the cisplatin does though, is make the radiation more effective, so my side effects from the radiation are worse. My treatment team believes that this will give me a higher chance for a cure though, so I think it has been worth it.

My husband also had the Cisplatin with radiation to make it more effective. He then had Erbitux a few months later because he had a recurrence. The Erbitux had more side effects than the Cisplatin. Just like Margaret stated the skin rash was the worst of it. He had cracked fingers and toes but that all cleared up pretty quickly once he was off of it. Good luck to you both.

Sue

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.