Okay Here is the results of my RO visit today
As far as IMPT, read the post above. As far as brachytherapy or seeds, he has done quite a few but the "hot spot" problem (the cells right next to the seed) in my case would cause cartilage necrosis in his experience.
So that only leaves Cyberknife. He is getting a PETscan for me next week and then he is going to use some snazzy new technology that overlays the entire radiation fields of my first 4O IMRT over top of the second Cyberknife fields and then adds in the PETscan results of the tumor activity. Then he can see if there are enough areas and vectors to hone in the Cyberknife beams to kill the tumor without causing a cascade of necrosis that would mean I would have to have my larynx out and have a permanent trach. He pointed out that 97GY is quite a lot and there is a danger of closing out my airways entirely plus other very bad results with more radiation..
He thought that the NIH trial Brian found for me would be my only viable option if the fields overlap too much.
Needless to say, my wife was disappointed. It did not help that the resident was so excited to meet me because I contradicted what he had been taught in medical school about maximum radiation. the only good news out of all of this is that the RO feels this is a new cancer, not a recurrence so it's not like this is a totally radiation resistant cancer.
So the waiting begins again
Charm