Please be sure all possibilities have been explored to find your husbands primary tumor. For reference, I had several scopes, a PET/CT, Hi-res CT, Sonogram and Surgical Exploratory with biopsies concurrent with the Selective ND.

Normally a Comprehensive Cancer Center can find the primary and if not is better equipped to handle what will likely be more extensive radiation treatment planning (less targeted with more and broader fields which can lead to increased morbidity such as severe dry mouth and burn).

Basic NCCN Guideline recommendations for an Occult Primary include a tonsillectomy, neck dissection, HPV test and depending on the staging of the lymph nodes radiation or chemo/radiation.

Normally they take the tonsils with very wide margins so it takes a couple days in the hospital.

I suggest you ask about a selective neck dissection since these seem to have less long term issues.

Ask about advanced 360 degree IGRT systems such as Tomotherapy or Varian Trilogy, etc..) These systems can be programmed to paint the guesstimated primary target fields with radiation beamlets delivery in smaller fractions from more directions than used by most conventional IMRT systems and may substantially minimize problems during and after treatment.

Good luck