Update --- I have taken my husband to the Mayo Clinic in Rochester. They have suggested that his best chance is surgery to excise the primary tumor at the base of his tongue and bilateral lymph nodes. They will do this by making an incision from ear to ear (practically) and remove his lymph nodes and from that vantage point remove the tumor at the base of his tongue. They will give him a trach because the swelling will cut of his airway and then slip in a nasogastric tube for feeding. The trach will come out in one week after the swelling goes down and he will remain in the hospital for one week. He will then come home with the NG tube for an additional week. Two weeks later the RAD will begin. We were really conflicted in this decision because noone would give him a greater than 50/50 chance regardless of the type of treatment we persued. Today he saw a radiologist/oncologist who at first said that surgery would not be indicated but changed his position after really reviewing the tests and palpating. He said that Tom's primary site was small enough to be resected with the right surgeon. He thought that if the primary tumor was excised that he would have a much greater chance. So even though the surgery is going to be tremendously difficult given Tom's diabetes, we are going to do this in order to give him optimal chance for survival. Surgery is scheduled for next Thursday. Thank you for all your responses and I will keep you posted as to the results.