BOT treatments favor radiation and chemo first, and only if necessary then surgery. This is because when you start cutting on the base of the tongue there is always the chance that the amount of anatomy removed, or nerves severed in the process of tumor removal will cause LONG TERM REST OF YOUR LIFE, quality of life issues in speech, swallowing, tongue mobility, etc. So the general school of thought is chemo, which has short term consequences, radiation which has long term ones but which are not as severe as surgery, and failure of both those to completely eradicate the disease in that location, surgery, referred to often (when in the third position) salvage surgery. Don't let that terminology throw you.... it most often does not refer to dire situation though they can be in some cases. This is because the previous chemo and rads have greatly reduced tumor bulk and that means less invasive surgery.