I was torn between Stanford and UCSF because I am geographically located exactly in the middle. I ended up at UCSF, where I was treated by Dr. Jeanne Quivey a well published radiation oncologist specializing in head & neck patients, especially in IMRT. Did you ask them why IMRT is not an option? (although you have 3 world class CCC's all agreeing about the XRT - I would still ask, since it can preserve a lot more tissue, particularly your salivary and thyroid function). You may not be a viable candidate for IMRT, however many here, even Brian, did not have IMRT and are doing well today. Chemo protocols have changed a lot since I was treated. I only had Cisplatin. Many people are getting a "cocktail" these days with Erbitux or F5U and Cisplatin (as they have proposed for you). Like Jeff said they typically like to start RT about three weeks or so after surgery to give the wounds a chance to heal.

If it were me I would hit it with every weapon you have, especially since this is a regional metastesis. "Distant" metastesis would be a situation where a new tumor has shown up in the lungs, liver, kidneys or brain (caused by the primary). They can't detect tumors smaller than 2mm so it may have been there. I would imagine that the tonsil cancer was the primary -was your first surgery done at Stanford as well?

Whether your cancer was caused by HPV or not will not change the treatment protocol but apparently there is data so suggest that HPV induced cancers are more treatable and have a higher survival rate.

What was your original staging and why didn't you have RT/ct after surgery to begin with?

Sorry it was late last night and I didn't look at your name with the stating. T1N2BM(X??) is not that common, especially the T1 N2B combination.