I've seen other abstracts, actually dated, that did not show any real difference with the addition of adjunct chemotherapy. As I heard a saying, "You can't kill cancer twice, if it's already dead...unknown author. Thanks for your input, Brian.

i read that link and something does not seem logical. How do they draw a conclusion that adjuvant chemo is better. The base set were two totally different types of patients. oh well

The term adjuvant means to add to the primary therapy to help or modify it.

Like riding a bike: To get from point A to B, you need wheels, pedals and steering. To get to point B more efficiently you might add gears. By themselves, the gears will get you nowhere but added to the pedals, wheels and steering it will make your journey a whole lot more effective.

The study quoted by Paul was done at a time when the researchers were trying to figure out if there was a place for chemo. The study indirectly compared survival figures between those who had either surgery or radiation VS the people who had radiation or surgery plus chemo. Sound familiar?

Since that study was done, the researchers have indeed found a place for adjuvant chemo which is during radiation not after it.

I know HPV is not commonly associated with oral tongue cancers but does still factor in. Here's a study where 36% of oral tongue cancer cases were HPV+:

http://www.ncbi.nlm.nih.gov/pubmed/20413270

My husband was a patient through the VA and was biopsied and diagnosed at the VA. They did not test for HPV. His tumor started back of center and grew forward. He would have lost 75% of his tongue based on being seen right after diagnosis, but the tumor grew significantly in the six weeks until his scheduled surgery date and he probably would have faced a total glossectomy. The VA would not consider neoadjuvant treatment prior to surgery (the ENT said it does not result in less radical surgery) or chemoradiation as primary nor was he pointed to a clinical trial. So we looked elsewhere.

I haven't gotten a confirmation email from NCCN since I registered last night, even requested a resend and still no email. Checked spam folder. I really want to look at those guidelines.

I don't think the area for adjunctive therapy is done, just yet. Most of the studies were done early on, some which showed promise, needing more trials, while other studies did not show much benefit, but there are new drugs now, target therapies, that are being used in trials, and for local control, maintenance, chemoprevention, secondary tumor prevention in HNSCC like with with Erbitux, Tarceva (erotinib), celexobib (Cox-2), and combinations like Erotinib and Cox-2, which shows to be better combined, than either alone, in chemoprevention with premalignant lesions in head and neck cancer. There is a phase I and II trial with Everolimus as adjunct therapy after definitive therapy with no sign of cancer.

Primary chemotherapy in HNSCC falls into three main treatments catergories: (1)Neoadjunct chemotherapy, designed to reduce tuumor burden prior to definitive locaal control; (2) concomitant chemotherapy, and(3) adjunct chemotherpy, designed to maintain patients (or to prevent recurrence) after difinitive local contol.

[quote=mlgsings] I haven't gotten a confirmation email from NCCN since I registered last night, even requested a resend and still no email. Checked spam folder. I really want to look at those guidelines. [/quote]
You can start here -- the OCF website has a page on the guidelines. (Note that what is linked is from 2011, but it can serve as a starting point for you. Brian may know what is new since then.) There's a lot of valuable information in the main part of the site, and everything has been vetted for scientific/medical accuracy.

This is 2011 version, it was updated since on NCCN for 2012. Not much different, but did change some.

Sometimes they include BOT as tongue cancers, which makes it confusing. I don't think they specified. Also, researchers found, going back to research HPV cancers, some records, imaging showed that some HPV oral cancers originally diagnosed as such, were misdiagnosed, and were really oropharyngeal primary cancers, mainly BOT, tonsils. It is said 90 percent SCCHN HPV is in the oropharynx, mainly tonsils, bot. I've seen a number of instances with HPV oral cancer, that had a recurrence in BOT. Makes you wonder if that was the primary all along, and was missed, which does happen. Also, BOT cancer can move forward, and usually not with front tongue cancer moving backward.

Thanks for posting the article, and continuing discussion.

The NCCN Guidelines are not updated every year, if there have been no significant changes. Since OCF isa partner to NCCN, we are notified of the changes as they happen, and we are one of the few places where you can find embedded in our site the actual reports and not links to the data, which often require a password/account to access in some areas.