Slava,

I'm very sorry to hear this, and don't know what to say, other than grasp for ideas, and saying what were some of my experiences.

Chemoradiation is often the preferred treatment, which was mine too, for certain cancers, its location, size, other reasons, including the patients condition and wishes.

I had heard of chemo being directly injected into tumors, but never came across anyone who did this nor was it ever suggested to me. Now I see it's with nanoparticles. Chemo by itself is not curative. It may shrink the tumor or sensitize it for radiation. If it does eliminate it, like my case with Induction chemo, it most likely will return, and did.

The radiation given seems kind of odd not knowing the type of radiation. It could have been something like Brachtherapy (internal rads) and then boost dose with IMRT (external rads) , which is similar to what I had twice, but with IORT, Intraoperative during surgery and IMRT a month later, and the next year IORT during surgery again and then Proton Radiation a month later. Usually with Squamous cell carcinoma, it takes above 50Gy to kill it, maybe more like 70Gy.

As far as jaw reconstruction with a free flap, which I had, it does need vascularization, and I was vessel depleted from prior surgeries. You can be considered vessel depleted due to the condition of nearby vessels from radiation too. They used my internal mammary artery and vein used from my chest, which they have to break, to attach supply blood to the fibula on my jaw. There are others that can be used too.

The liver may be an issue, but was never mine. Mine is stage 4 chronic kidney disease, but they still did surgeries. Many trials have reasons for exclusions, and I wouldn't qualify for most, if not all, but that never prevented me from receiving treatment, maybe some types of chemo's though.

Keytruda and Opdivo are not curative, works in about 14-18% head and neck cases, but some do have durable responses. Their being used with other chemo's and combinations in some trials, but that may mean more toxicities.

I also say to confer with the top cancer centers who are very experienced in recurrences and complicated surgeries. In NYC, if that's an option, as is time, and your brothers condition is permitted. They have doctors that are very experienced with complicated cases, some of the best in my opinion, and you have about a half dozen top places one can go to that are close in proximity. Maybe even seeing all in one or a few days for the best options.

I wish your brother the best, and hope this helps.