Sabja --

You had about the same diagnosis as my husband, (right tonsil, base-of-tongue and two nodes but they staged him III/IV at Hopkins) -- he had 7 weeks tomoTherapy IMRT and 7 weeks chemotherapy (carboplatin only, this was just before Erbitux was available). He had a complete clinical response and is considered cancer-free per a battery of scans and tests. He didn't have surgery other than tonsillectomy of primary tumor (no ND). His cancer was also strongly HPV-16 postive.

Mouth sores should start to ease about 5-6 weeks after the end of radiation, but there is the possibility that the Erbitux, which affects the epithelial growth factor, might slow this a bit. Various agents can help -- our dental oncologist, an expert in the side-effects of mouth and throat radiation, told us one of the simplest was a salt/soda rinse several times a day. The coating agent Gel-Care (a prescription material but there is an over-the-counter equivalent made by same company called Rincinol) can help coat the sores and allow eating.

Be sure your pain medications are sufficient -- you should not be stopped from swallowing by severe pain. You may need to talk to your doctor about this -- most who receive radiation need to use fairly serious drugs, often the Duragesic (fentanyl) patch which is good for 3 days, plus an opiate such as oxycodone for break-through pain. Do not be afraid of addiction, if you have *real* pain the risk of habituation is much less. Unfortunately many doctors/hospitals fall down on providing adequate pain relief, per head of Hopkins Pain Management Center.

As for dry mouth, it is due to the radiation damage to your salivary glands. These may recover somewhat and in the meantime you shoukd be careful to use artifical salivas (esp. Oral Balance) which will in part replace the important enzymes which protect your teeth. Ask about the drug Evoxac which is the best drug to promote salivary funcion. At Hopkins it is often given to patients during treatment if the dentist notes lack of mouth moisture. My husband started to take it after treatment, his radiation plan protected much of his salivary glands but there was some damage. The Evoxac has worked well for him and he is now down to 1-2 tabs a day (from 3) -- this 16 months out of treatment -- but in order to work, it does require some salivary function to have been spared. I know someone who has received acupuncture for dry mouth with considerable success, you might look into this as well.

The fact your cancer is HPV+ is, as you know, a positive prognostic factor -- the rate of recurrence is fairly low (less than 15%, according to most studies) compared to HPV negative HNC and the cancer itself is more sensitive to radiation. My husband is now in a clinical trial for a new therapeutc HPV-16 vaccine at Hopkins, which if successful, in the future may well be a major weapon in the arsenal against this form of oral cancer.

Gail