WOW! What else can I say. Such positive, insightful, thoughtful, and empathetic responses.

My limited experience compared to folks like you all strongly suggest TPF side effects are generally manageable, maybe even less problematic than the standard CRT with platinum. If the frequency of nasty, long term, side effects was even reasonably probably it seems to me the medical community, being that it is on balance, very conservative, would have warning flags about it and the regime would not even have FDA certification.

Even though today I lean toward doing TPF induction sequence then CRT, the topic of second opinions often arises. This may sound elementary, just what is the definition of second opinion?

I guess I feel I have "second" opinions at hand. I am VERY VERY lucky to have a HNC surgeon who received a fellowship at MSKCC in head neck cancer not all that long ago, so that alone offers me extreme comfort. His parting words at the initial consult was be aggressive! The MO seems quite competent and after thoughtful and careful study of my case, suggests the induction due to the length of time the cancer has been there, migrated to lymph nodeS, the spots in the lungs on the PET-CT, and the potential for loose but undetected cancers. The RO is the one who presented the alternate position - induction studies are not complete and side effects can impact the main CRT series, so his position is to be more conservative and pass on induction.

My very long time primary, who I do not see now (insurance related), called me last night to check on me, and her words echo many - get aggressive and go after all the cancer the first time leaving the lowest potential for recurrence. I'm sounding like a broken record.

All my doctors are actually associated with different hospitals (insurance) and doctor groups; collectively comprising an enormous library of experiences that checks the "second opinion" box for me.

Finally, my case goes to a tumor board next week so there are other numerous professionals that will weigh in. Never been to a cancer tumor board before, thank God.

Living in a metro area of 6 million plus people offers many excellent choices and very good quality choices including world class centers of excellence. The centers I go to are large, well equipped, handle high volumes of cases, and staffed with many professional with vast and differing backgrounds and experiences. This seems like another inherent source of "second opinions.

Obviously, my confidence level is pretty solid with the resources currently available to me

Am I missing something?

The only other option might be to seek out opinions from the other two local main research CC nearby: Stanford Cancer Institute and UCSF Cancer Center. I do not think those are options (insurance); although, I have not explicitly inquired as yet and hear the clock ticking louder each day to get some treatment going and arranging these alternate reviews is going to take time, even if they can be contracted.


Thanks
Don