Hi,

I'm wondering if it's better to do radiation first or the Neck dissection first.

My sister (39 yrs old) was diagnosed with Base of Tongue cancer on December 5, 2004.

My sister lives in Victoria, BC, Canada and sometimes it takes a long time to schedule a surgery date in Canada. A surgery date suddenly opened up on Dec 15 and my sister had the tumour removed and a partial glossectomy.

Her ENT could not even schedule the CT scan before December 27.

The initial CT Scan showed no cancer in the lymph nodes but a second CT scan on Jan 14 showed an enlarged lymph node.

A biopsy of the enlarged lymph nodes confirmed that it was cancerous. As well, we consulted a second ENT (in Vancouver) who feels, from the size of the node, that the cancer must have broken through the lymph node membrane.

My sister's radiation oncologist feels she should undergo radiation first.
The second ENT feels she should have the Neck Dissection first and radiation afterwards.
The first ENT (in Victoria) is away on his honeymoon and had left instructions to proceed with radiation if cancer was found in the lymph nodes.


Apparently, you have to wait 6-8 weeks between radiation & surgery regardless of which occurs first?????

I'm just wondering if there's any consensus out there ..... which course of treatment should proceed first -- what has everyone else done?

Thanks for any help you can offer.

Amelia

Hey Amelia,
Dan had the radical neck dissection first and then chemo/rad. I have read that others on this board have had the rad first and then the neck dissection. The problem Dan had was that he had to wait many months before getting any physical therapy and it would have been better to start sooner...scar tissue had already set in and he lost some movement because of the delay in PT.
God bless,
Debbie

This is a difficult question to answer and depends on many specifics of her diagnosis, staging, recurrence and other issues. In some instances radiation is used first to shrink a tumor and reduce the margins prior to surgery. The risk in this is that radiation slows and impedes the healing process.

The other scenario is prophylactic radiation done post surgery and that can damage the healing process.

It's a difficult treatment no matter what order.

There should be a meeting of the minds between the radiation oncologist and the ENT based on the best outcome for your sister. Tongue cancers tend to be more aggressive so whatever is the most conservative approach is what I what do. I would probably throw chemo at it too if it were me.

Amelia, my surgeon and radiation and chemotherapy doctors all agreed to do the rad/chemo first and then the surgery. This was primarily so the tumor could be reduced in size and to lessen the risk of the tumor bursting and leaving cells in the body which might lead to a recurrance. Without the rad/chemo first, my surgeon indicated that splitting the jaw bone and removing major muscles and nerves might be required in my case. He also said that doing rad/chemo fisrt could make the surgery more difficult, therefore more risky and possibly less successful. Given that, I opted for the chemo/rad first. The end result was my surgery was fairly simple, though almost twice as long as initially estimated and the doctor had to scrape the areas around arteries and nerves. I also only lost about 8 oz. of tissue and no activity on the bones at all. I had IMRT rad, cisplatin chemo every 21 days, and modified radical neck dissection. However, I was a tonsil primary, not a tongue primary, so the treatment regimen may be different.

Amelia,
I had the neck dissection surgery first as I wanted the lump out of my neck ASAP. I had no known primary so other surgery other than some teeth removed prior to rad. Radiation could have started 5 weeks after surgery. Guess it depends on how quickly you can get to surgery. Did either dr give you a reason for their preference or is ti because 'I'm on my honeymoon and can't doit now'? Maybe time for third opinion.

Take care,
Eileen

Hi Amelia, that may sound a difficult choice to you. My case is fairly similar to Kirk Georgia except that surgery was not necessary when I finished chemo and radiation treatment. Since the tumors on both my tonsil and neck lymph nodes were enormous,surgery would cover an extensive area that would lead to drastic complications. It was the intention to get the chemoradiation first to reduce the size for easier operation. Very luckily, after treatment, I was in remission already. I waited for a month after diagnosis to have the first treatment and during that time I think the tumors were still growing and that month was an unbearable one and I also wished that the doctors could remove the tumors as soon as possible.The waiting time was necessary because of a series of tests and preparation for the treatment. I am happy now that the doctors have made the right decision for me.

Hello Amelia
Our choice was to get Radiation and Chemo first. Luckily enough that seemed to do the trick, the reasoning we used was the dissection could always be a second option. As you can see it worked for us , Pete had a stage IV bsae of tongue.
Whatever your choice we pray for the best possible outcome for your sister and your family.
Marica