There could be involvement bilaterally, due to the highly lymphatic area, and musculature of the tonsil into the BOT, that can spread to both sides, more so with BOT near midlline. Most tonsils cancers are on the left side, but can be right ipsilateral or bilateral. The tumor is large at T3, and that usually has higher rate of metastases, lymph nodes involvement, but see N0, but could be microscopic, and undetectable now. I wouldn't want to go through treatment twice, I actually did. Your first shot is the best shot.

Is this a trial with Erbitux? It's really not the current recommended first time treatment, outside clinical trials. I would want to add some other chemo, in addition, like Taxotere. Cisplatin was recommended, in addition, but read something from MSKCC with disappointing findings with this combination, but there are other findings noting a higher response rate. Chemo will add 8-22% better response to treatment, depending on type.

I had bilateral IMRT 70 Gy with T1N2bM0 disease. They might do lesser to the left side, and cervical neck.

Good luck.


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