KimRuth,

Just to add to Gary's comments, I think whether or not lymph nodes are removed for a Stage I tumor varies from doctor to doctor. The ENT who did my initial surgery and tumor removal did not do a neck dissection to remove lymph nodes and said that there was no need to.

Brian has repeatedly noted that there is micro or occult mets in about 30% of Stage I diagnoses which, in part, is why I sought a second opinion in Boston.

The ENT in Boston who is monitoring me now said that he always does a neck dissection for Stage I and removes 1-3 of the closest nodes. This, he said, enables him to biopsy the nodal tissue and either confirm that there is no micro mets or not. If there is, then he knows that he has to remove more nodes and can also better gauge how aggressive treatment regimen should be.

Also, your original question asked about IMRT and the lack of a target. Often the target will be the tumor bed and the closest nodes to the tumor location. Using IMRT can increase the precision with which any area can be targeted and will also spare adjacent tissue. - Sheldon