Virginia, This must be another issue where the treatment varies widely among various treatment centers. My husband had a small primary SCC BOT tumor and one swollen lymph node when he was first diagnosed. His CCC, Moffitt Cancer Center, decided to do surgery first and then radiation. They had planned to do a selective neck dissection which became a modified radical neck dissection during surgery when they found that four lymph nodes had cancer and the cancer was also affecting a nerve and muscle. He had 15 lymph nodes removed and definitely has had lasting effects such as shoulder weakness and pain since they cut into nerve endings. PT, and now exercise, seems to continue to improve this, but he was told it would probably take a year to heal fully.

Everyone's situation is different but then the treatments across cancer centers seem to be different even for similiar cases from what I've read on this forum. I suppose you would have to be familiar enough with H&N studies to analyze the mortality and QOL outcomes to come to your own conclusion.

I have the complete document for one of the few studies benchmarking treatment outcomes of head-and-neck cancers with use of IMRT treatment. According to this study, "combined surgery and postoperative IMRT produced improved locoregional control and DFS compared with definitive IMRT (IMRT alone). This was in part a result of patient selection, because operable lesions tend to be smaller and have favorable features". This particular study also found no "statistical significance between IMRT alone and the patients treated with radiochemotherapy". However, it notes that three other meta-analyses showed that concomitant administration of radiation therapy and chemotherapy led to an absolute benefit on 5-year survival rate of about 10%.

I think the decision for surgery or not usually depends a lot on tumor volume and other factors. But as I said, different centers seem to have different approaches to the same situation as well.

Best wishes to you both. Connie