My husband is currently undergoing 39 IMRT treatments. He had a modified right neck dissectomy and right tonsilectomy. I have noticed in postings that almost everyone has had some type of chemo treatments. My husband is not. They feel it was contained enough that he does not need them. Can I get some feedback on this?

My husband went through 35 IMRT treatments and didn't have chemo either. I don't know all of the technical terms, but they caught his cancer early and it was a slow growing type of cancer, so his team of doctors decided radiation alone would be the proper treatment for him. Hope this helps.

Shelley

Chemo only got added on to my husband's treatment when pathology revealed that there was extracapsular spread of a cancerous lymph node. If it weren't for that, he would have had only radiation.

Anita

Quite a bit of research seems to show that chemotherapy added to radiation does produce a significantly improvement in local control and survival rate compared to radiation alone. In fact, chemoradiation (often without any post-treatment surgery) is done at most of the top CCC's for HNC. I have read ~10-15% improvement but that varies by who did the research and the stage of the cancers treated. The chemo is given to increase the sensitivity of the cancer cells to radiation; it is often (but not always) a lower dose than would be given if the chemo drug were the primary therapy.

The downside is that toxicity of the treatment and intensity of side-effects also increases, sometimes to the point where treatment has to be delayed. (Which can reduce treatment effectiveness.) So there is a balancing act involved.

Both the CCCs at which we consulted prescribed chemotherapy alone (for my husband) -- he had already had his cancerous primary (right tonsil) removed but no surgery to the lymph nodes nor to the residual tumor at base of his tongue. However they differed in which drug. We went with carboplatin which was almost a non-event, compared to the radiation and the amifostine (!).

Gail and Barry

I to had chemo with radiation.
Darrell

I had concurrent chemo-radiation treatment to beat my very advanced tonsil cancer. But I could spare the surgery which so many posters here underwent in the end because after the treatment, the scan tests didn't detect any more cancer cells. So everyone is different and the doctors should be able to design the best option plan for their patients. I once worried that if I didn't have any surgery, would there be cancer hidden somewhere not yet killed. So my worry seemed to be rather unnecessary since I have been in remission for over 4 years now and am doing great. Trust our doctors. They should know which form of treatment suits their patients best.

Karen

The NCCN guidelines for treating oral cancer is a good place to check to see when concurrent chemo is recommended--and they have changed soemwhat on this in the last year I think.

http://www.nccn.org/professionals/physician_gls/PDF/head-and-neck.pdf

According to the now-guidelines, I really didn't need chemo. But when I got a second opinion at Dana Farber, they recommended chemo with the radiation, even though I was stage II and had clean margins (they weren't sure I did after the first surgery but in the second one he took more tissue and it was cancer free so I think that really means I had clean margins all along--just not enough tissue wsa removed in one spot to tell the first time around). The medical oncologist there admitted this was a more aggressive recommendation, but there were some other risk factors associated with my tumor and eventually I came to see it his way--if there was a chance it could help the radiation be more effective, why not?

The two really big research papers on concurrent chemo do show a 10-15% improvement in local control, as Gail said, but the majority of research participants in those studies (all of them in one study) were stage 3 or 4. My medical oncologist said that a good rule of thumb is that since stage 2 folks in general have 1/2 the likelihood of local recurrence of the more advanced stages, you can estimate the chemo would prduce half the benefit. That's still a 5-8 % improvement in local control, which sounded like it was worth it to me. But again, that's kind of a loose estimate, not based on clear data.

Nelie

Thanks for all your input. I did check the guidelines and his treatment is within the guidelines for the stage of cancer. Your right Karen I should trust his doctors and I do trust his doctors. He is treating at a wonderful CCC - Fox Chase and his doctors are great. Sometimes I still question things.