We asked our radiation oncologist at Hopkins this exact question on Tuesday (as Barry may also get a recommendation for lymph node removal subsequent to his chemoradiation, completes 9/28, when we see his ENT Monday).

He said, lymph node removal may add 10-15% to local control but then added, however, and this is a direct quote, "there is no evidence for a long-term survival advantage." I have not had a chance to follow up on this although I know there have been some papers recently concluding that neck dissections are deinitely recommended in certain cases but not in all.

Post-chemoradiation ND surgery is not done routinely at the three top CCC (MDAnderson, Sloan and Hopkins) but that reflects in part the make-up of the staff. Our RO said that, for example, at Sloan the surgeons very pro-neck dissection left for other positions and the replacements are less proactive on this issue. A Hopkins it is considered "controversial" (our medical oncologist's words) and many radiation patients are declining the surgery or adopting a watch and wait position. Btw, they would not s the surgery until after the 2-month checkup which is the first time they look seriously to see how well the cancer has responded.

If you are so uncertain you may well want to take him up on a "second opinion", perhaps from a non-surgeon, maybe your medical oncologist or someone recommended by him/her. Do not be reluctant to seek a 2nd opinion, it is not a sign of lack of trust of your doctor, it is simply good medical practice and in fact, recommended by the American Cancer Society in such cases.

I would also ask your surgeon some hard questions -- such as, what in his experience are the differences in control and recurrence in patients who have had or not had ND at your institution. Your husband's cancer was poorly differentated and this might make a case for node removal; the surgeon can explain this more fully. Also, what side effects might your husband experience? A lot of folks on this list have had ND and many have said it was less traumatic than the chemoradiation.

The long and short of it, get as much input as you can and make your decision.

Good luck,
Gail