While I had a known primary, as someone who was treated with what were essentially only three angles of radiation (front, left, and right) and who had a field of radiation that went from my TMJ to my clavicle, I feel ok to comment on this approach. Will the treatments (as with most field radiation) be brutal? Yes, but highly doable with the expected mouth sores, (mucocitis) and exterior skin burns, and subsequent permanent dry mouth. Many, many posters here, especially those of us that went through treatment before the days of IMRT, made it through and dealt with the issues. He will endure and prevail the treatment issues as well. Long term, now years removed from the event, I am pleased with the quality of my life, and I believe had they not hit my stage 4 cancer with the biggest hammer around, I would not be here today. Does radiation itself cause long-term issues? You bet. But none of them are horrible, and what is the option? Being on the wrong side of the grass.

It is not unusual to have an occult primary, but it is not as common as having a finite site that is definable. What you are suggesting (that they radiate the nodes only) is a mistake in judgment. The nodes are NEVER the primary or only location of the disease. They are the first sites of metastasis of that disease. Your doctors sound like they are approaching this with the right attitude and technique.

For anyone who goes through radiation and chemo treatments there is a significant drop in their quality of life during the treatment process. This is not a walk in the park, this is cancer. But patients rebound in time. That is what you have to stay focused on.