Hi all,

My brother-in-law (BIL) was diagnosed with NSCLC stage 3B along with base of tongue squamous cancer stage 1 (December, 2009). He is 61, good health, ex smoker. Tolerated an aggressive treatment plan for the lung cancer and is currently with no evidence of disease in his chest since September. December PET showed one lymph on the left side of neck. Decided it was time to tackle the head and neck.

He went into surgery for removal of the tongue lesion via the daVinci robotic surgery. Staged T1N1 with margin of the tongue resection free of tumor. At the same time a selective neck dissection was done and 5 lymph were removed, only one positive for metastatic carcinoma, measured 1.2cm. Because robotic surgery is only done at a few centers, it was done by a surgeon not involved with his NSCLC.

His lung cancer ONC is recommending Erbitux plus full radiation to both sides of his neck. The surgeon recommends only radiation to one side of the neck. Also because he had good margins and only one positive lymph some studies recommend nothing further.

My questions to all of you out there, have you faced these types of dilemmas? Which is the best way to go? Does he really need that radiation overkill?

I have been reading this site for several weeks and have acquired much knowledge from many of you and I thank you for that. Would appreciate any experiences or feedback.

Diane

Diane,
He is definitely on the fence about radiation, however, a positive lymph node bumps his staging up to Stage II or even possibly III, so multiple modality treatment is typically called for. The radiation is brutal but tongue cancers tend to be very agressive and the fact he also has nodal involvement is probably what is driving their recommendations. If the surgical resection hasn't gotten 100% of the tumor then there is a chance of a recurrence within the first year and that can be very serious.

Why are surgeons making recommendations about radiation? That should be the RO's job.

Erbitux is pretty frequently used now, but I wouldn't be surprised if they recommend adjunctive platinum chemotherapy, such as Cisplatin - to enhance the radiation.

Cancer can easily migrate to the other side so bilateral radiation is quite common.

If I were in his shoes, I would be going for the most aggressive treatment possible, especially with his prior history of cancer.

Nodal involvement pushes the staging to a III but it is unusual to have bilateral nodal cancer. That being said I had radiation to both sides with only one positive node without a smoking history and the effects of the radiation to my neck area were/are really nothing so I would be more interested in the safety of having it done to both sides especially if that's what your team recommends.