"with surgery still being the mainstay as 1st line (old school and not in practice at the main CCC's anymore for most cases)."

Michael, this really rubbed me the worng way. As Brian pointed out, you have had the rare luixury of speaking to several docs at two of the major CCCs but do you really know enough about what is practiced at the main CCCs in all cases to make this statement? When I went fir an opinion at Dana Fraber, like you, I had already had my surgery. But they would have recommended I have surgery first if I had gone initially. They are the #4 CCC in the country.

One difference between me and you is my cancer was on the upper tongue and surgery was not likely to produce extreme problems that would have hurt my quality of life such as being unable to speak or swallow--whereas my udnerstanding is often cancers on the lower tongue or tonsils have potentially many more complications. So maybe that's why some of the other places told you they would do rad and chemo first and only use surgery after if needed.

I'm certianly no expert either, but I suspect whether surgery is considered to be the first line of attack varies based on a number of factors, even at the major CCCs, which is why the NCCN guidelines are written the way they are.