Hi Paul --

Do you have any earlier CT scans from which the doctors can evaluate the rate of progression of your cancer? This might make them feel more comfortable with a delay, as IMRT is considered a big improvement over conventional radiation re organ preservation and targeting. Don't be hesitant about asking hard questions about comparative side-effects of the two approaches.

My husband Barry has stage IV as well, right tonsil (removed w/ clean margins except 1 cm of tumor left on base of tongue), also mets to 2 lymph nodes on right side. He had a CT scan last November when one of those nodes was diagnosed as an abscess, and Hopkins compared these with CT scans from earlier this month (post-dx). In 8 months, there had almost no change so the radiation oncologists opted to wait until they could get him on the new tomotherapy machine (sort of a souped-up IMRT). That wait is 3 weeks post-simulation (which was last Monday) and everyone is comfortable. But if it had looked like things had been moving aggressively, they would have gotten him onto the IMRT in 2 weeks. (Two weeks seems to be about the standard time needed post-simulation to do IMRT planning).

Gail Mackiernan