Which radiation treatment is best for SCC tongue base tumors and lymph nodes in neck?

Laralyn said:

Welcome to the site! :-)
I

Welcome to the site! :-)

I had HPV+ Stg IV in my left tonsil, one lymph node, and soft palate. It's an interesting question! From my perspective, the answer has two parts.

Part 1 is about the technology. I asked my radiation oncologist (Dr. Deepak Khuntia) about Tomotherapy before I started, because from what I had read, it was superior to IMRT in its targeting--which helps avoid salivary glands. My doctor said the only Tomotherapy machine in the area was about 60 minutes away (in good traffic... and traffic in the SF area is rarely good). He said he did think Tomotherapy was better technology and that in fact he spoke on behalf of the company that invented it because he believed in it. The hospital where he practiced, however, only had IMRT (but new equipment). He said that the location and size of my cancer meant he could take the time and map it well, and get similar results with IMRT as he believed I would get from Tomotherapy. 

Part 2 is about the people. You need to have a trusting relationship with the people treating you, and you want the best you can get. Dr. Khuntia was one of the few head and neck cancer specialists in the bay area. When I asked him about getting a second opinion, he said the only other radiation oncologist he would recommend for H&N was Dr. Le at Stanford (head of the radiation oncology department, and also a H&N specialist). I did research on Dr. Khuntia and it looked like he was excellent. I also liked the facility and the rest of the staff. It was also close to home (20 minutes). Based on all of that, I decided to be treated by Dr. Khuntia and have IMRT.

So I would look at both of those elements. Get a second opinion from both facilities and research the doctors. The technology matters, but so do the people. For the last 2 weeks of treatment and checkups for a few weeks afterward, a shorter drive can feel like such a relief, too, so you I would consider that as a minor factor as well.

As a side note, Dr. Khuntia left practice shortly after completing my treatment... to become the VP of Medical Affairs for Varian, the company that makes Tomotherapy machines! So he put his money where his mouth is--and that makes me believe even more that it's a superior technology.

Thank you for your insight.  I suspected I would need to make this choice soon and last night got the word from my surgeon that the lymph node had extrascapsular involvement so I will need chemo/radiation.  There is a TOMO place about an hour from me and IMRT 20 min.  The relationship with the provider is important to me as well as the technology so you really hit the nail on the head.  Not looking forward to this next journey as I am just now starting to feel like a human being after the surgery. 

fishmanpa said:

Tomotherapy

Hi PJ,

 

Welcome. This is a great site for info and support. Please make sure to check out the Superthread. It contains tons of great info.

I was Tx N2b MO Stage IV HPV+. I had Tomotherapy done at Johns Hopkins. It's more accurate in delivering the radiation with less colateral damage. I still took quite a beating though. It rotates 360 in a spiral around your head. It also does a  CT scan just prior to the rads giving it even more accuracy. As I recall, 22 rotations, about 15 minutes total and treatment was over!

Positive thoughts and prayers

"T"

How do you use superthread?  Have not figured that out yet.

fishmanpa said:

No reference

Hi PJ,

Since everyone reacts differently to treatment, it's hard to say if I fared better or worse. It's safe to say I did better than some and worse than others. However, for whatever reason, I never lost my taste buds throughout treatment and at 5 months post treatment, I have about 70% of my saliva back. I still have swallowing issues but that's mainly due to the surgeries prior to treatment. That's improving as well. 

The Superthread is a read only thread at the top of the forum page. It contains many subjects and informative posts about a variety of subjects. Just click, scroll and read. 

FYI... my tumors were extracapsulated which necessitated the use of chemo with the rads. The platinum based chemo drugs (Cisplatin/Carboplatin) assist the rads by radiosensitizing the cancer cells. It also helps to eradicate any stray cancer cells that may have gotton onto the lymph highway. 

Positive thoughts and prayers

"T"

Thank you.   PJ