Rosemary:

I did think of one additional point to share driving into work today and I share it not to scare you but to hopefully aid in your decision making process about the value of post-op radiation after neck dissection.

As it was explained to us by Dave's surgeon, the number of nodes removed from people during neck dissection varies as does the number that can be visualized and fully assessed in a surgical specimen. For example, your daughter had 15 nodes removed and identified and 4 were noted to be positive. Dave had >30 removed and one was positive. It is not uncommon for there to be variability...

The surgeon explained that there are also often more nodes in a surgical tissue sample than can be identified and assessed on the final report because some are so minute they can't be separated out from the tissue.

That said, he also explained that you can never be 100% sure you got a "completely clean" neck dissection (although most experienced head and neck surgeons can give you a play by play about how well they think they did and how confident they feel about the surgery based on their experience doing so many of these procedures).

So, the long answer here is that radiation therapy acts as a vehicle to erradicate any microscopic disease left in the tissues themselves and in any "teeny tiny" nodes that may have been inadvertently left behind during surgery because they couldn't be seen.

Caveat to Brian-I am repeating what Dave's surgeon told us when we inquired if he "really needed " radiation. Please feel free to help me out if my explanation needs your expertise to further clarify.

Thanks,

Kim