I'm fairly new here, and posted last week in "introduce yourself" with my situation, originally with stage 4 tonsil cancer with neck node involvement in 2009, and 3 local regional recurrences in the left neck since, and now with microscopic cancer with postive margins remaining after this last surgery still in the left neck with Perineural(PNI)and Lymphovascular(LVI)Invasion.

I was offered reirridation with IMRT at 50Gy for 5 weeks, concurrently with Erbitux weekly infusions at Mt. Sinai in NYC and the same with a local RO and MO, but wanted to seek other options due to the total dosage to my left neck would be 110Gy.

On Monday I met with Dr. Harrison, RO, at Beth Isreal Hospital in NYC, author, and renowned radiation oncologist, especially with Brachytherapy, and one of the top doctors in NYC and country. I went there thinking about the Brachytherapy, and he was recommended by another blogger here on OCF, along with this treatment, which is good for reirridation and with less toxicities. I met with one of the assistants first, and gave him my huge volume of medical files, and finally met with Dr. Harrison. You can tell he is an brilliant man, an intellect, and he thought deep when speaking. Dr Harrison immediately said I have a complicated case, and see I had a number of recurrences, that can be difficult to understand. He immediately said he reviewed my history with his associate, and there is only one thing, and one thing only, that can be done, and done safely! Dr. harrison said he would explain it to me first, and then it would be for me to decide. I was unprepared for what he told me.

It's a four part process: 1. Do neck surgery again, clean up any remaining cancer. 2. While the neck is open, do external beam radiation in the operating room 3. Do a flap with the chest muscle, and put the chest muscle on my neck, so there is fresh tissue on the neck 4. Once healed, do radiation on the neck and maybe Eributux.

This is called Intra-Operative Radiation Therapy (IORT), and is only done in a few locations in the U.S. Dr. Harrison is a pioneer with this procedure, invented some devises for this, and has done several studies at Beth Israel hospital and formerly at Memorial Sloan Kettering in NYC. As discussed, reirridation is too risky for the carotid artery, having already done IMRT at 60Gy, and 2 neck surgeries on my neck, and the dosage wanted to be done elsewhere at 50Gy will not be enough to kill the remaining cancer. He also chided me having a network of doctors all over NYC, and said I need a multidisciplinary team with everything done at one location, not all over like previously done..it's a long story.

I like Dr. Harrison and have confidence in him. I met with Dr. Jacobson, ENT in Hae, who does the surgery with Dr. Harrison. He said it won't be easy, and explained the risks, espcecially with my prior treatments..35 IMRT with 70gy, 60-62Gy is adjacent areas, radical neck dissecction and another dissection to levels III and V. he also thinks I have no other choice either since the cancer is microscopic, had 3 recurrences already and just a metter of time before it comes back, and possibly metatastesizes to the organs.

Sorry for the long post! I'm finding out more about IORT on the internet, but would like to know if anyone else knows about this,had it done or knows someone who did or has any other infomration that is helpful?

Thanks.