In my cancer diagnosis I have been receiving radiation only, ie no chemo. Several on this forum have mentioned they thought rads with chemo is the way to go. As you can imagine it has caused me to question my treatment protocol and ultimately to ask my doctor point blank did he think I needed to be getting chemo also. He shook his head NO. I asked could he explain further.

He goes and gets a copy of the NCCN (National Comprehensive Cancer Network) Guidelines for my diagnosis (tonsilar cancer for T2N0 staging). And there it is in plain english, for this diagnosis radiation only is the recommended treatment plan.

He then offers on his own that the downside risks of chemo for your diagnosis are riskier than the benefits you will receive. So, for your diagnosis it's radiation only.

If your diagnosis changes then we will consider chemo. I asked how much change for that. He says lymph node would have to grow to larger than 1cm size and give doctor reason to think it was involved in the cancer. I expect I would then receive a fine needle aspiration biopsy to confirm cancer and surgical removal prior to chemo.

For those of you not familiar with my case, my first CT showed one lymph node same side of neck as tumor swollen to about 1cm size. As part of my treatment simulation they run a second CT. On this CT lymph node swelling had gone down back to normal size.

I hope this helps future patients.

NCCN guidelines indicate 3 modes of treatment for T2 oropharyngeal. 1. Radiation 2. Resection of primary with ipsilateral or bilateral neck dissection 3. Radiation with systemic treatment (chemo/targeted therapy), It's just a guideline, and not set in stone, and other matters are taken into account, and if adverse effects still show they move on to the next step. Your next step after radiation, if it fails, is really salvage surgery, not chemo, which doesn't kill this cancer, and would only be palliative. Chemo could be used with radiation after surgery.

Good luck.

Hi Tony, I too was in the same situation as you and was very worried about not getting chemo along with the rads. I trusted my dr and hoped for the best.
All the best to you also!

Hi Tony,

Obviously no doctor here but throwing 2 bits in anyway. You are T2n0 which means the primary tumor is pretty small and no metastasis at all so there is good reason to believe the cancer has not spread at all anywhere, even microscopically.

Chemo can and is used to kill microscopic cancer that escapes from the primary. It also is used as a radiosensitizer to improve the radiation therapy.

Given the radiation can target the primary effectively quite well and low concern of micro cancers, it seems quite reasonable that your case does not warrant chemo dosing which does carry sometimes significant downside risks.

To add, complicate matters further, chemo is sometimes used as "adjunct treatment", after radiation, Chemoradiation. How long, I'm not sure, maybe piggybacking on making radiation work better, as mop up for any microscopic cancer, which can't been seen by the eye, testing, only in pathology under the microscope. 1cm is small, but not microscopic, and to my understanding, radiation keeps working just as long as treatment lasted, like 6 weeks. One risk with adjunct chemo is "radiation recall." Some I know of are on Erbitux or Tarceva as maintenance chemo, mostly with distant mets, unresectsble tumors, but one of my oncologists was looking into it or me for "chemoprevention."

I had 35 IMRT, 70Gy, bilaterally, alone in 2011. My oncologist said my body would not be able to handle chemo then, a year after disastrous induction chemo. Radiation alone is being looked into, especially with HPV related HNC, which is different biology than tobacco/carcegenic related caused, but not all HPV related HNC are as favorable, a small group reacts like tobacco/carcegenic caused.

When they were poking and prodding me back in early 2009 my RO sent me to an MO for consultation. After my neck dissection I remember being in the ICU when the latter came in and told me "I have good news for you - no chemo." He seemed surprised that I wasn't more demonstrably excited. At the time, with an emergency trache in and more tubes than the London Underground, I barely could open my eyes.

The reason he gave was that there was no extracapsular spread from the 2 infected nodes, the larger of which had been removed a month or two earlier during my first neck surgery, when they still thought it was a cyst.

Maybe protocols have changed in the last two years?

Anyway I put my trust in my team and I'm okay now nearly 5 years later. I should add that the MO, just recently retired, was at the time a professor at the UCLA medical school, which is a decent place so they tell me.

FWIW...