I'm sorry for this news of your brother, Kelly. I have no experience with distant metastases, but know MD Anderson is the top rated cancer treatment center in the country. What I recall, and could be wrong, about lung involvement in HNC is knowing if it's metastatic cancer or a secondary cancer, both of which may be treated differently, have different prognosis. I heard of biopsies being done in the lungs to help confirm this, if it's possible. For small tumors, I heard of radio-surgery, like cyber knife, being used, and other therapies depening if its metatastic or not. I wish I knew more to help, and hopefully someone has some experience or knowledge in this area. You can always get 2nd opionion orveven 3rd opionin elsewhere. If I come across anything, I'll let you know. Take care.