Rick,

From your signature it appears that you are in the last few weeks of treatment right now. Your primary is obviously fairly small, comparable to mine, which was almost exactly 2cm, so right on the T1/T2 line. Where is the primary -- i.e. right side, left side, midline? You appear to have 2 nodes involved on the right, which would lead me to believe that primary is on the right or midline.

You can look at all kinds of studies, and go crazy doing it. All I can share is my experience and what I was told. At the time of diagnosis, I had one palpable node on the right, my primary was on the right, but just touched the midline. My team (ENT/Surgeon, Radiation Oncologist, Medical Oncologist) suggested that I have the neck dissection first, then proceed to treatment. Because my tumor touched the midline, they also suggested a bilateral neck dissection, just to be sure.

Their primary rationale was based upon the fact that the primary pathway for BOT cancer is the lymphatic system. By doing the dissection first, they can immediately cut off that metastatic route (to the extent possible -- they never remove all of the lymph nodes). The pathology then tells them what they are dealing with -- extracapsular spread, etc. That can then be accounted for in the IMRT plan and the chemo. They have achieved very good results with this approach.

Many institutions follow your path -- treatment first, then the neck dissection, if necessary. This path uses the theory that the radiation may kill all of the tumors, obviating the need for a neck dissection. Good results have been obtained using this approach as well.

If you are looking for "conclusive" studies, tough to do. Most studies that I have seen generally show better results for advanced disease where a neck dissection was done. However, there are so many variables -- number, size and location of nodes, length of time between diagnosis and treatment, etc. etc. It is difficult to quantify results in an individual case.

I can tell you that the surgery itself is not bad. A few days in the hospital with some drains hanging out of your neck, and some funny looks after you get out, as your neck looks a bit Frankenstein-ish. I was back at work in no time. Long term you can have shoulder/neck stiffness and pain, depending upon the type of ND, but that is more luck of the draw than anything.

Everyone is different. I wanted to throw everything I could at this disease, so doing the ND was a no-brainer, especially since they felt they could eradicate the primary with radiation/chemo. Other folks want to hold something back -- radiation, ND, whatever. Individual choice.

I just had my latest follow up with my RO, and got another clean slate, so their program has worked for me for just about 2.5 years since diagnosis. Do get your doctors to talk to each other. That is really, really important.

Best of luck!