My brother has been told that unless it can be demonstrated that there is less than a 1% risk of his experiencing a cerebral metatastic-related acute incapacitation he will not be allowed to return to work until 24 months post-treatment, in line with the improved prognosis at 24 months. The report from the neurosurgeon that his employer referred his scans, reports etc etc to, contains references backing up this position. Mention was made of BCL2+ and the reduced consequent prognosis of HPV 16 when it is present. Does anyone know what that is?

the first obvious question is why is a neurosurgeon involved? why don't they ask Simon's doctors or at least an oncology expert?

In my area, BCL is short hand for B-cell (memory cells involved in regulating the immune system) but I am not sure if this is what it refers to here (wonderful thing about medicine - the same nomenclature means different things in different disciplines). BCL2 positivity was floated as a marker for prognosis in cervical cancer years ago but results were inconsistent, and as far as I know the idea just petered out. I am not sure what possible connection this would have with Simon unless his lab results indicated a BCL2 positivity and research into correlation between BCL and HPV has progressed into head and neck cancer. The first step would be to check the references that the neurosurgeon has provided to make sure he isn't applying results from cervical cancer studies to Simon's case. If he is, another expert could easily rebut such a conclusion.

My only reading of any connection between BCL2+ as a marker for prognosis and HPV is in cervical cancer. For every experiment that found a correlation there was another that found none.

Might I suggest you or Simon talk to his radiation oncologist and get them to look at the report give his view and possibly explain the significance of the neurosurgeons conclusions?

sorry to be so vague - I am really not following the thinking here ...

I'v seen BCL marked as a negative factor for H&N cancer, but in the following article it looks like he has sailed past the scariest part of the survival curve. The other articles I've seen (but can't put my hand on) indicated that if something bad were going happen, it would have happened already. The interaction between the various factors is complicated, to say the least.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640025/

I would be surprised if they have enough data to support the 2 year mark for this small subset of patients in a meaningful (statistically speaking) way. My guess is that they are using the more general 2 year benchmark.

BCL could be "Basal Cell Layer" also, which is below the Squamous cells.

Things sure are different in different countries! Best wishes with this!!!

Is this related to Income Protection Insurance through his employer�s Insurance Company?

Karen

It's not to do with insurance. The neurosurgeon is involved because my brother is an airline pilot and their medical people have tried to ascertain the risk of metastase-related seizure whilst flying 400 people around. They want this risk to be less than 1%. They would be happy if it can be demonstrated in other studies rather than the ones cited. They have ALL his MO RO and ENT scans and reports but are asking for guarantees that may be can't be given. I don't have the references cited by the neuropsurgeon but will get them today so thanks for the leads. If anyone can suggest anything else I'd be grateful.

Maria , that is so helpful. Where in that study does it say that he is past the high risk period? I think they are using the 2 year mark, but they're not wanting a less than 1% chance of arecuurance but a less than 1% chance of a seizure. After a week at work (I'm a high school teacher) I reckon my risk of a seizure would be way passed that! When I get info from the report I post some of the details and the studies.

I hope everything works out so your brother can return to work.

Karen

I work at a software company and my probably of a seizure has GOT to be higher than 1%, too. I'll try to get more details on the timing issue for you.