Your doctors know best, and wonder if they are suggesting which way to go? From my view, most of the previous studies, statistics are not based on
HPV status, which is different in biology, response, and prognosis, as you know, and its own entity, so it's hard to compare all the info out there, but there does seem to be a more aggressive type, recently identified as type B
HPV, in one report, which may not mean much as yet.
I'll try to answer the questions from the numerical list off the top of my head, and questions prior to this not numbered, to what I understand or may not.
1. No. There are no guarantees, and there could other risk of spread indicators such as ECE, but will be identified during surgery, pathology or skip metasteses. There are over 300 lymph nodes in the neck anyway, most microscopic, so a neck dissection may not get them all. You say selective neck dissection, but that usually level II-V with the sparing of one or all of the structures..vein, nerve, neck muscle, so it may be less than that with a limited neck dissection, involving one level, no more than two.
2. Anything can happen. Cancer can go anywhere. I had a RND, and cancer was found in my neck muscle, and had several recurrences after that with "no lymohs" which is basically roaming cancer cells now that can go anywhere, and went to the elliptical layer of skin.
3. IMRT has been around since 2000, so who knows. There is risk of a secondary cancer due to radiation leakage, especially IMRT, for every 10 years. Side effects are acute, less than 3 months, and late stage, more than 3 months. There are longer known effects as your doctor mentioned.
a. That's a planned neck dissection, regardless if the are no obvious signs of cancer. Some studies show there is better control with a planned neck dissection vs watch and wait, until there is a recurrence.
b. For tumor kill the dose has to be over 50gy, and for the cervical neck usuallly about 60-62Gy is given. I don't know of anyone getting 70Gy for all areas. Each structure has a total dose toxicity, such as salivary gland, brain stem, brachial plexus, so IMRT dose paints those areas according to thier toxicity limits.
I hope this helps, but not really saying which direction to go. Chemo is another story, and I'm more afraid of that due to my negative reactions, but seems like you did the first dose, and hope all went well.
