To add to the above, you already commited to not having surgery first, so you can't second guess now. Anyway, most oropharyngeal patients (BOT, Tonsil) have chemoradiation, instead of surgery, being it preserves swallowing function, and other structures, as opposed to having surgery, which can be debilitive, and use "Surgery as a last resort" or as "Salvage Surgery."

Oral cancer is usually with surgery first, which you may be seeing more often here with these patients, and some have radiation, and or chemoradiation in addition. There is some difference in treatments in oral, and oral tongue as opposed to oropparynggeal, which includes the BOT, tonsil.

NCCN guidlines also include different methods for IMRT delivery, including 6 days, Stimultaneous Integrated Boost (SIB) between 66-74Gy to the gross disease, and is used in both "conventional treatment" and 6 fractions/week "accelerated" schedule. 180cGY for 7 weeks comes to 7560cGY or 75.6Gy, which seems over some some toxity levels, and above the target level above (66-74GY), but depends on the type of delivery, which can add more safely. If it's 2Gy daily, for 6 weeks, which serms used more often in the "accelerated schedule", that comes to 7200cgy or 72Gy, which is within the NCCN target levels, and below the unaccptable toxity level above 75GY. You may want to ask the dt about this, and if you want 6 weeks, if it can be done, the daily fractions may have to increase to 200cGy instead of 180.

Below is a randomised, multi-center trial for five versus six fractions of radiotherapy per week for squamous-cell carcinoma of the head and neck showing to be more effective.

http://www.ncbi.nlm.nih.gov/pubmed/20382075

Good luck with everything.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs