Cancer in throat that has spread to glands in the neck.

Dear Sir, I need your kind help regarding my father cancer. He has a Cancer in throat that has spread to glands in the neck. Which treatment would be better for my father? Cyberknife treatment? or VMAT? or chemoradiation? "Hydrogen Peroxide Cancer Treatment, nitrogen flush" "transoral laser microsurgery" ? Thank you very much for your time and help. Thanks and Regards, Naresh
Naresh Agarwal

I hope I posted the as much details as possible related with the my father test report for your all advice.

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At present able to eat near normal food consistencies orally OSME - mouth opening good, tongue ROM good FOIS - 6 PSS HNC diet - 90 100 mL water swallow test - able to swallow well, laryngeal elevation good, pre and post swallow voicing good Clinically funtional swallow

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RT OPD 59 yr M, R/o Kolkata k/c/o HTN and DM, PTCA with stent-2011, chronic ghutka chewer p/w swelling in Rt lateral neck X 2m No h/o dysphagia/Hoarseness/change of voice/aspiration O/e at presentataion: Proliferative Growth On The RT Side Of Epiglotis With Extn To PE FOLD & AE FOLD Both VC mobile CXR-NED FOL (26/10/16): UPG inv Rt LPW, Rt PE fold and adjoining epiglottis Superiorly reaching epiglottis Inferiorly upto AE fold B/L cords mobile B/L PFS clear FNAC Rt cervical node-( TMH review-28/10/16) - Met SCC CT neck and PNS(2/11/16): 1. 2X 2cm Mass in Pharyngeal surface of epiglottis on Rt inv PE fold, reaching upto vallecula and Rt AEF just reaching medial wall of Rt PFS 2. Both free edge and root of epiglottis involved 3. inv of preepiglottic space and rt paraglottic space with lesion just reaching upto Rt FVC 4. BOT/PPW/laryngeal cartilage/ B/L TVC and FVC/subglotiis free 5. Rt level IB, II and III necrotic nodes with PNE - largest 3X 2.6 cm compressing Rt IJV and abutting Rt ICA with loss of planes for angle of contact less than 180n degrees O/e: Gc fair, KPS 90, Wt-78 kg OC : Mo adequate- 4 cm , moderate oral hygeine, dental staining +, no mass seen or felt in oral cavity, BOT felt and free, FOM free Hopkins: Neck : 4 X 3cm Rt level II node, hard. fixed, non tender with restricted mobility Imp : Ca Supraglottis c T3 N 2a M0- SCC

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DIABETES SINCE 12 YEARS HTN SINCE 6 YEARS PTCA SVD 5 YEARS ECOG : 0 - Fully active, able to carry on all predisease performance without restriction. Karnofsky : 90% - Able to carry on normal activity; minor signs or symptoms of disease.

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CT SCAN OF THE PNS & NECK DATED 25.10.2016 Contrast enhanced CT scan of the PNS & neck region has been performed from base of skull till root of neck on a MDCT scanner. This is a case of supraglottis for evaluation. A heterogeneously enhancing mass with necrotic areas within is seen epicentered in pharyngeal surface of epiglottis on right and involving the pharyngo epiglottic fold, reaching upto vallecula and right AE fold, just reaching upto the medial wall of right PFS. Both the free edge and root of epiglottis are involved. There is involvement of the preepiglottic space and right paraglottic spaces with the lesion just reaching upto the level of false vocal cords on right. Base of tongue is free. Posterior pharyngeal wall is free. There is no extension across midline. Laryngeal cartilage framework is intact. The true and false vocal cords and subglottic are spared. It measures about 2.0 x 1.9 cm. Large necrotic nodes with perinodal extension are seen at right level IB, II and III. The largest at right level IB measures 3.0 x 2.6 cm in maximum axial dimensions and compresses the right IJV and abuts the right ICA with loss of planes for an angle of contact of less than 180 degrees. Rest of major vessels appear free and patent. Thyroid appears unremarkable. The oral cavity is unremarkable. Paranasal sinuses and orbits are clear. The parotid & submandibular glands are unremarkable. Visualized lung apices are unremarkable. Visualized bones show degenerative changes. CT study reveals heterogeneously enhancing mass with necrotic areas within epicentered in pharyngeal surface of epiglottis on right with extent and associated metastatic cervical adenopathy as described. Consultant (