First, uptake with PET/CT at this date after end of treatment is quite common and does not necessarily mean there is still cancer. It is just as apt (probably, more apt) to be inflammation from the healing process, and in some cases, local infection. The radiation continues to work for weeks after end of treatment and thus 3 months is earliest date many recommend for a first scan, with another 3 month later to see what's happening. The radiologist who read Barry's PET/CT (who only does H/N and brain scans) says that with an expert reading the scan, there is still a "gray area" of uncertainty as well as about 5-7% false positives. This percent would be higher with a radiologist who only reads a few HNC scans a year.

Had an interesting talk last Friday with the medical oncologist at Hopkins who is the principal investigator in the HPV vaccine trial my husband is in. We asked her the rate of recurrence of HPV+ cancers (which tend to be tonsil and base-of-tongue, and also, poorly differentiated), and then, where recurrences would be expected to occur. She replied that they almost always returned in the neck lymph nodes. I asked if it made a difference if the patient had had a ND (my husband did not) and she said not really. She added that "ND is falling out of favor" (a quote) and that this was a hot topic at ASCO (Am. Soc. of Clinical Oncologists) meeting this year. Apparently some papers presented showed significant increased morbidity with ND and no improvement in long-term cancer control.One paper I looked up (from Fox Chase CC) showed a doubling of time for feeding tube dependence with ND, for example.

What I am leading up to is that you should definitely consult with a medical oncologist as well as the ENT (who is a surgeon and of course favors surgery). ND is supposed to add about 5-10% increased local control to the treatment but is not showing increased survival.

Gail