How does the rd oncoligist decide what type of RD to use? From everything I've read the IMRT is less damaging to the mouth glands than the shotgun approach, What do they base their decision on or is it my decision? My wife is a nurse and leans towards trusting the surgeons. I am less trusting.

IMRT is not offered at every institution, and is not for every patient. This is the function of several things. It is expensive equipment and some facilities have not had it on their budget to get it as part of their armamentarium yet. Radiation oncologist around the US are just in the last year embracing this technology for oral cancers and many are still in a learning curve, compared to its longer term use in brain cancers for instance. The docs at the facility that you choose may not be up to speed yet. It certainly has less long-term negative effects than field radiation. It will probably come down to a decision of how confident the radiation oncologist is in his ability to map out the tumor and all the possible routes of metastasis (that currently do not show any involvement) to be radiated. It is a function of knowing where this disease goes as a matter of experience, and planning radiation for those areas and missing other vital structures where possible such as the salivary glands or cranial nerves. You and your radiation doctors will decide together if it is right for you. With all respect to her nursing background, your wife's perspective that the surgeon should make the decision about your treatment comes from a lack of experience and knowledge related to this disease. A treatment plan decided on by a group of doctors from varied disciplines and backgrounds always yields a better long term out come. If all you have is a hammer...everything looks like a nail. A tumor board will involve lots of different specialties of doctors and you will get a comprehensive treatment plan from them.