Thanks for all the input! Based on both empirical and anecdotal data, I'm pretty much convinced that chemoradiotherapy is the best first line treatment for most HPV+ cases. Nonetheless, in my case, I've decided to proceed with the surgery. I spoke at length with my RO who is also the head of my multidisciplinary team at Johns Hopkins. They're concerned about the potential for a combo of radiation and chemo having a negative impact on my MDS (possible relapse) or my graft versus host disease (possible exacerbation). Thus, they hope to avoid chemo altogether. They'll make a recommendation about radiation after the status of my lymph nodes is confirmed. If deemed advisable, they still hope to use a slightly reduced dose. I'm already at high risk for MDS relapse because I had multiple complex chromosome abnormalities and all three cell lines affected. I guess I'll also be at higher risk for scc recurrence without the chemo. It feels like I'm walking a tightrope here! Unfortunately, there's a lot of guesswork involved due to the rarity of this combination of factors. I'm wearing my lab rat t-shirt I got at NIH last year when I volunteered for their graft vs. host disease study. I never dreamed that my rat career would grow more extensive.