This is at the moment an issue of some controversy (a direct quote from our MO) -- it really depends on the training, experience and outlook of the doctors treating you. Our RO told us about one of the current top CCCs where in the past the HNC "team" was strongly influenced by its surgical component and that at that time most of the HNC chemorad patients also got NDs. However, when that doctor left for another position, taking a number of his colleagues with him, the same CCC now does not recommend ND if the post-treatment tests show apparent complete response.

At Hopkins this seem to be in transition, the MOs and ROs have published quit a bit on "chemoradiation as sole treament" but I get the distinct impression that some of the surgeons would willingly do a ND if the patient consented. Some patients do and some do not. All get checked out by ENT after treatment and they can make their decision; Barry declined it (he had already had cancerous tonsil removed pre-treatment, clean margins except for small remnant at base of tongue and none of the surgeons wanted to touch that.)

The ENT who did his surgery is herself opposed to ND without demonstrated need, she has not found it provides any long-term survival advantage, though a relatively small % improved local control (5-10%, the same figure given us by the Hopkins ENT and RO). The published literature varies in its conclusions as to the advantages of ND -- some studies have shown no advantage, some show the opposite.

So the issue is at best confused...the best advice is to ask several of your doctors as to their thoughts as to the pros and cons...

Gail