My surgery date is scheduled a month from today, on October 16th. The ENT is going to resect the tumor in level III during a radical neck dissection, and Radiation Oncologist, Physacist do High Dose Rate Intraoperative Radiation Therapy (HDR-IORT), which are photons produced from a high dose rate gamma emmitting radioisotope with Ir-192 mounted on a mobile afterloader (phew), with various sized flexible applicators used to deliver radiation, that can be fitted to any location, crevice, with the molded HAM Applicators, which my Radiation Oncologist designed, to the area, with a large single fraction that is administered at the time of surgery in a large fraction dose between 10-20Gy, which is equivalent to 20-45Gy in IMRT, and thst is usually no more than 2Gy each day, so its like getting 4 weeks of radiation at once, and primarily focused on a surgically exposed tumor or tumor bed while the other healthy organs, and tissue, are either shielded by lead shields or displaced from the radiation field.

This is my second time with IORT, my 4th radiation Tx, that basically a newer type form of brachytherapy. My first was with 15Gy, probably equivemant to 45Gy, and then addition 50Gy of IMRT, with chemotherapy for 5 weeks later on. I don't think I'll receive further radiation this time having radiation with a total of 150Gy or 210Gy that is equivalent to IMRT, and the oncologist laready said no chemo.

The advantage of HD-IORT is its ability to use a higher radiation dose while reducing exposure of normal tissue, and with patients with recurrences that were previosly treated with radiation. This takes coordination with the Surgeon, Radiation Oncologist and Medical Physicist to see if it's possible, and are there during surgery to perform set-up, measure tumor area, pick out appropriate HAM applicator, calculate dosage, do control checks, and do the radiation after the resection.

The special OR is completely shielded by lead. There are only a few like this, maybe 5, in the country, otherwise one would have to be transported from the OR to the radiation department to have radiation, and back to the OR again. This OR has a lead shielded room, adjacent to the OR, to house the whole surgical team where I'll be monitored by 7 CCTV, intercom, remote applicators, monitors, delivery system for the anesthesiologist, nurses for vital signs, and to remotely do radiation, which can be up to 60 minutes. Maybe I'll finally be able to meet the elusive physicist, but doubt it, and the Wizard will probably be behind a closed doors, and I'll be knocked out lol.

The concern is the toxicity level to the carotid artery in my case, being the tumor is close to it, and my prior radiation Tx, among other concerns like the tumor being small at 3x7mm making it difficult to find, but the ENT is confident he knows where to find it. The carotid artery will be shielded with molded lead, as well as other vital structures, which is not possible with other external beam radiation, like IMRT. Last year's surgery took 5 hours, but I think it will be less time being I already have the pec flap, and there is not much to remove from the three prior neck dissections, but who knows to what extent surgery will be until it's done.

I'll probably be in the hospital for several days, and believe last year it was four days. If it is, it will be four years from the date I was diagnosed with cancer.

Paul, your treatment plan sounds like it is a good one. Wishing you all the very best with everything you are dealing with.

Thank you, Christine. I have excellent doctors, and my RO is an expert in IORT, brachytherapy, head and neck cancer, and knows head and neck anatomy better than any surgeon, other surgeons have said, so I have confidence in them. Sometime after healing, I have to do HBO again to have my teeth removed

Hi, Paul -
Glad that you have a plan in hand. You might ask to meet the elusive physicist - you will probably get the 'long answer' to whatever you ask, but I'll bet that it would be interesting.
My very best wishes during the waiting and for the upcoming procedures.
Maria

Thank you Maria. Off to see the Wizard .....

Good news Paul and I certainly am praying for wisdom and guidance for your medical team. I'll sneak in another request for the Wizard to appear. You certainly deserve it with all the magic you have mustered up in this long and drawn out battle. You are an amazing man!

Get well and maybe we can plan 20-30 scuba dives so you can enjoy the dives at least. Hang in there. I would imagine you have some sense of relief but a bit of worry mixed in over the next month as you prepare for yet another round.

Thanks. It is a relief knowing where I'm going. I do have some concerns, and one is recurrences before surgery, which happened twice last year after two cancer diagnoses only to have two recurrences before surgery. In one way I'm lucky in finding them early.

Tell them to cook it good this time!!! Hugs!

Just reading the treatment plan is fascinating and I wish I could be there to see this nut obviously I do wish that you didn't have to go thru this but let's hope they accomplish everything they hope for.

Thanks all! It's really the only thing that will help at this point for a cure. Surgery alone, probably not, but that's even better than nothing. I'm surprised not many have this done for recurrences, at least from my readings, and neither did I until last year, and would have done it earlier. Goes to show what one doctor may not or can't do, another one may. I didn't even consult for a 2nd opinion at this point, and even MSKCC didn't want to see me last year for some reason, maybe after hearing who the RO was that I was consulting with, who was head of brachytherapy there for 10 years. He told me I know you have been shopping around lol, and you will not get a better offering than this, and was true.