My treatment for tonsil cancer, and two lymph nodes, in 2009 was adjunct chemo, followed by Chemoradiation for preservation of swallowing and function, which was popular at the time instead of the morbid split lip surgery. If there was residual cancer or it recurred then they would do "salvage surgery" or "surgery as a last resort" as it's called to the primary or lymph nodes where there was radiation.

Over the years, I've heard of both, upfront surgery before treatment, which I believe MSKCC was doing before undergoing Chemoradiation in 2009, and mine at Mt Sinai, both top CCC, were doing Adjunct and Chemoradiation, and surgery as a last resort, and other variations.

Mt Sinai were also one if the first to do TORS, which I inquired about, but was told it I couldn't do it due to the number of cancer areas involved. I think at the time, TORS was just for tonsil or BOT primary with no neck dissections, and may have since changed. At a later time, another possible recurrence, I was told I couldn't have TORS because of my limited mouth opening from radiation

Subsequently, I needed salvage surgery to my neck for a recurrence. As far as the neck dissection, it was supposed to be a modified radical neck dissection, but during surgery, everything was all twisted up from radiation, so I had a radical neck dissection, which removes the lymph nodes level ll-V and the vein, nerve and neck muscle.

There are positive and negatives with both, one negative being radiation does make structure changes as mentioned, so surgeries can be a little more difficult, and with TORS, Microscopic Laser Surgery, and Endoscopic surgery, the idea of surgery being upfront seems popular again too, and heard of other variations with no chemo, lesser radiation, etc. depending on other negative or positive features. .
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