Some positive news

I received a call from the RO on Monday. He said that he has carefully mapped this recurrence and found it to be just outside the SBRT field we treated last time. The area that was treated is perfectly clear of cancer.

This is the risk we take with SBRT (Cyberknife). They use a very precise target area when reradiating patients who have already had IMRT treatments. The goal is to limit any extra radiation damage to healthy areas while it the same time killing the tumor. If the field is too tight, some cells may be missed and will continue to survive after treatment. This appears to be what happened to me.

The good news is that this is not a radiation resistant recurrence in the old tumor area. It is fresh cancer that was missed in the last treatment. Radiation seems to work in killing my cancer it�s just that my treatments keep missing a few cells at the margins or in the first case a lymph node.

So the RO feels confident that he can treat this new occurrence with another round of radiation. It is down at the bottom of the treatment area so the field will not intersect any soft tissue in my oral cavity which is great news as I could not stand more necrosis in the mouth. It is also far enough away from the carotid to limit damage there. Also, it is much smaller than the last treatment area (mm instead of cm).
I may suffer from some additional fibrosis in the neck muscles but I am prepared for that.
The tumor board meets on Monday night and my case will be discussed. The RO said this occurrence may just be far enough away from the carotid to allow for a surgical solution but wanted to get the surgeons take on it before going there. Of course I would prefer surgery but it�s a long shot given the amount of radiation damage in that area. Apparently, surgeons hate going into these �Woody Neck� areas where the tissue is like �concrete� (the words of the surgeon at Sloan Kettering). But the real determining factor will be distance from the carotid and margins.

So the positive take away here is that this is treatable with a hoped for curative outcome. I�ll post again after the tumor board gets back to me.