I tried to post some questions previously and based on other member's suggestion, I decided to first introduce.
My Dad , who is 68 years old was detected with Oral cancel. After all tests it was confirmed to be in T2N1M0 Stage. The surgery was done on 21st April and they had removed 16 nodes from the left side. 15 nodes were negative and 1 node is found to have extensive spread and also while surgery they found that the spread is out of the node to sorrounding tissues.
Now , the doctor has recommended a Radiation + Chemo therapy for 6 weeks. Which is planned to start from 21st May. The Radiation is going to be IMRT for 6 weeks ( 5 days per week). But one of the doctors is suggesting that dont spare the Perotic gland. Is this right approach or sparing periotic gland is fine. One Doctor is syaing that sparing periotic gland can cause under-radation.So, advice on this really helpful.

subujee,

The perotic is fairly large and spans the back of the throat. I lost a part of that gland but not all of it. The question is one of targeting.

I think with todays technology, they can target well enough to spare parts of the perotic, but it all depends on where the primary tumor is. My primary was on the soft palet, right side, just in front of the perotic, so I lost the right side of the perotic but not the left side.

Please fill in your signature line as you lern more about your fathers condition. In the mean time I would find out if they are talking about losing the entire perotic or a partial loss.

Thanks Kelly. My Dad's primary tumor is on the backside of tongue. The doctor had mentioned to radiate the complete perotid gland. Now, my understanding is that based on organ the radiation can be controlled. Now, if the peritod gland is not affected by cancer, is there any risk of spreading to it if its not sufficiently radiated? what they call under radiation?.

The key here is the field of radiation being applied. This includes where it comes in and where it goes out. They shoot the radiation from a number of different angles so only the tumor gets the maximum dose. The parotid is behind the tissue at the back of the throat and is not connected to the tongue so it will not be a place the cancer will spread, but it will be in the field where the radiation is either going in or out.

The reason it is damaged is because it falls in the field of radiation needed to treat the tumor. By changing the angles they shoot the radiation into the tumor (they hit me from 5 different angles every treatment), they can change the field to minimize the effect on the parotid, but if they change the angle too much they will not hit the tumor with enough radiation.

I still think that the question at hand is how much of the parotid they will be losing to radiation. I lost half but have good saliva from the other salivary glands, so my dry mouth is not that bad (it�s not a good thing either).

Also, different people react to radiation in different ways. People here will tell you that we all have different outcomes from radiation.

Hope this helps

Was he a tobacco user?

Kelly got the idea and answer right, but you have two parotid glands, they are the major producers of all the saliva in your mouth and they are damaged because they are in your cheeks (not in the back of your throat) in front of your ears, and all the way down near the edge of your mandible, right where a lot of the radiation has to pass through. Remember that the people programing IMRT and other targeted software controlled radiation delivery techniques these days, have to know anatomy like a surgeon. They are doing their best in each patient to deliver the maximum radiation for effect while mapping around vital structures that the consequences of damage to are long term QOL issues. They map as much away from your spinal column, major nerve bundles, salivary glands, etc. But at the end of the day, there are thousands of angle to approach something from, and not all of those angles will cover the needed area and still COMPLETELY spare something like the salivary glands. They not only map areas, from a pin point to a brush stroke - but intensity and diffusion of the beams, so there is a lot to consider when the personal map for any patient is drawn.

Brian and kelly thanks a lot and this is an excellent forum. I am still learning about this procedures.And David to your question, yes my dad was a tobacco user and he was a smoker too.
I have another question. Now, 10% of my Dad's tongue is removed and also the affected Node was removed. So, what will the Radiation target now ? ..there is no tumour there anymore?.Could it be the cells sorrounding the tissue where the node was affected to prevent future recurrence?. And also the doctors are taking about targetting on both sides of the neck with Radiation and a Chemo Blast of 3 cycles. Is it necessary to target both sides of the neck or only one side where the tumour was there ?. Is this the standard process everywhere?.
Also, they are planning to start doing a baseline MRI/CT Scan next week, which is 3 weeks after surgery , won't it show false inflamations at the place where the surgery is done? .Is technology so sofisticated to distinguish
between false inflamations and cancerous cells? ..They are not doing PET Scans..rather relying on CT /MRI scans.

OSCC has been known for a long time, and its behavior in many ways is well understood and predictable. That statement is not an absolute, as all the people on this board will testify to, as there are individual idiosyncrasies too numerous to mention.

So, we can predict that even with clear margins, the likelihood that there are some micro metastasis, that are too small to even show up on any type of scans, into the surrounding tissues is something we should treat for even though we can't see them. Ask how many people with surgical only solutions have recurrences (the wrong word.... I think I will gain the wrath of most otolaryngologists when I use the phrase "incomplete primary treatment", which attorneys like to use a lot) in about 18-24 months after they were told that the doctor "got it all". The answer to that question is too many, by the way.

We also understand its known pathways of metastasis, how it usually (nothing is 100%) wants to go south into the lymph system and the cervical nodes found in the neck, and if not caught there into the chest and the vital organs where the consequences become increasingly dire. The chemo is a radio sensitizer to make radiation work better...think belt and suspenders.

Doctors decisions can be highly conservative, or unspeakably cavalier and disregarding of clinical experience in the big institutions. So be thankful that the team he is seeing is the former not the latter.

PET scan immediately after any treatments are notoriously full of false positives as they are not a test for cancer, but sugar uptake which is also a by-product of the healing process. MRI's and CT's do not have this issue but look for soft or hard tissue abnormalities.

Lastly re the tobacco. When this is the etiology, there is an issue of field carcinogenesis, which I have explained on these boards a few hundred times, so please take a run through the search engine. Short answer is that he has contaminated a large area that is more than his mouth with his habits/life style, and the cancers associated with each anatomical site occur at different times.

Dad's Radiation and Chemo plan is pretty much finalized.
One doctor's opinion was to go for Cisplatin but in weekly doses vs. the typical 3 intervals. But, the team of doctors which have finalized the plan is going for typical 3 intervals Cisplatin 100 mg. Radition is IMRT 6 weeks with a total of 60 gy.
Any pro- cons for the Cisplatin in weekly doses vs the 3 interval high dose blast? .

Medically speaking there is no comparative study that I am aware of showing one method is better than the other but it appears just from the posters on this site that the ones that have had it weekly do not suffer as much in the nausea dept and don't seem to complain as much about the ringing in the ears and permanent hearing loss as the ones like me that got the 3 big doses.

I was just on a panel discussion at Moffitt and I talked to Moffitt's head of Chemo and they still go with the 3 doses.

This is just my opinion but since your Dad has a tobacco history I would go with their recommendation of the big 3. Do tell him to listen for "ringing" in his ears or anything that sounds different in his ears and if he experiences that to tell his chemo doctor asap as that can and usually does lead to permanent hearing loss. Most that have a rough time with Cisplatin are often switched to Carboplatin for their 3rd dose or they just don't do a 3rd dose.

I might also recommend that he ask for a pre Cisplatin Tx hearing test so that he can establish a hearing base line to better establish any hearing loss post Tx.