HPV16+ SCC diagnosis - is chemo really necessary?

I agree with chill maybe a second opinion would be in order. I do note that your husband had surgery whereas a lot of the H&N cancers are treated with no surgery but with a combination of radiation and chemotherapy. So maybe this doctor is correct in his case. As far as the chemo drugs I was under the impression there were chemo drugs tailored to fight almost any cancer. The radiation would get rid of any errant missed cancer cells in the area of his cancer but chemotherapy travels throughout the body affecting errant cells elsewhere. No matter what you decide you want effective treatment and be as sure as possible to get this cancer the first time, a one-shot deal if you will because you don't want to go through this again. I found some info on the net also.

Why would you have chemotherapy and radiotherapy together?

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Radiotherapy uses high-energy rays to destroy cancer cells. The chemotherapy drugs can make cancer cells more sensitive to radiotherapy. Combining both treatments is often more effective than having either treatment on its own.

Please note last cancer I had was lymph node cancer and was operated on and the recommendation was radiation follow-up only, no chemotherapy. So I had 30 treatments with the Cyberknife.

So I think it is done both ways with or without depending on your case.

Each case is different and there are times when just surgery is used and if they are confident they got clear margins when they operated or say taking out a lymph node or thyroid gland where it is all retained in the gland and they are confident they have all cancer removed. Or two methods may be used as in my case and your husbands and I getting surgery and radiation and I believe there are times when all 3 are used.

The reason many H&N cancers are treated with chemo and rads is because it is successful usually and avoids disfigurement and other problems from surgery. When I had my first throat cancer my ENT told me if I would have had it ten years earlier rads, and I think mostly the chemo wasn't as developed, and the only way they could treat it was a major operation and probably in my case a pretty big operation.

Mainly you and your husband have to be comfortable and confident in whatever treatment he is getting to get rid of this the first time. Are you confident in your doctor? Talk frankly with your doctor and ask him the chemo question and any other questions you have before you move forward and if you are uncomfortable maybe a second opinion is best. Don't worry these days doctors don't mind. Here is a link with info to read in the meantime maybe it will help.

Another link-

And here is one more link about treatment from Johns Hopkins-

I hope it is not too much info but you can just read what you are comfortable with.

Wishing You The Best-=Take Care-God Bless-Russ

I had HPV+ cancer of the tonsil (well technically the arch between the tonsil and base of tongue...but who is counting). I had a neck dissection and they removed 3 lymph nodes, 2 of which had disease. The stars lined up for me and I was deemed low risk so had only TORS surgery to remove the tumor followed by a slightly lower than normal radiation dose (60gy vs. 70gy). I just passed my 5 year diagnosis anniversary in January and in April I'll be 5 years out from end of treatment. :-)

Typically if you have any high risk features you end up getting the standard of care which is radiation+chemo (and optionally surgery if they think its worth while). High risk features would be extranodal extension (which you maybe mention in your original post?), history of smoking, a tumor that is near the midline of your body, etc...

Similar to my treatment regimine, the Pathos trial is looking to study whether reduced treatment is as effective as the current standard of care. They are hoping that for certain patients with a certain risk profile, less chemo or less radiation will be as effective as the standard chemo+radiation combo...and if so, will translate into equal outcomes but with fewer long term side effects.

Long story short...chemo+radiation does ABSOLUTELY work for HPV+ cancer...it's the standard of care. The trial you are participating in is studying whether reduced treatment is as effective for different populations based on risk profiles with a better or reduced rate of long term side effects.

Brandon

I was part of a trial called EVOLVE through Sanford Health. I received 2 smaller doses of chemo during my radiation treatment and was told it was just to enhance the effectiveness of the radiation. I had neck dissection, tonsil removed along with a sliver of my tongue and a portion of my soft palate removed during the surgery. I was very happy with my results but I am literally 12 months out of treatment so hopefully it worked!

I was 44 at the time of diagnosis, surgery and chemo/radiation. I was in pretty good shape so I think my age/health was a positive in me recovering. Oh, and my docs said I was a stubburn pain in the a$$ becasue they gave me a goal of walking the halls each day I was in the hospital and I doubled their goal 3x each day because I wanted my lymph system to work and heard that could help.

Surgery recovery was difficult. I spent 5 nights in the hospital and couldn't sleep at all as I felt like I was choking. I was on a feeding tube the entire time but was able to swallow hot chocolate after the 3rd day (painful) and after 8 days I could eat mashed potatoes and gravy and different soups. On Thanksgiving, I was able to eat some of the stuffing/dressing with gravy and it tasted wonderful.

They warned me it could be like that and my surgeon wanted to make sure he got all spots. I feel very fortunate that I have been NED for the year and am at my "new normal" which is pretty darn good. Some foods still aren't exactly right but really, really close. My saliva has recovered to about 50% (my guess, not medical) but I still notice dry mouth pretty often which makes exercising and eating some foods more difficult.

I went through something similar. I had Tors surgery and neck dissection both sides with several positive nodes on the right side none on the left. I had a medical team on the tumor board. The decision in my case was Tors, and 33 radiation treatments to the right side. The decision for no chemo was made because of no extension of the nodes and lower level was clear. This was made after the path report. I opted for a 2nd and 3rd opinion before I chose Tors, rads knowing full well there would be chemo if I had extension. I was also P16. A second opinion wouldn't hurt if you feel you have the time. Good luck and God Bless.

I had Proton rads only for right side tonsil cancer with one lymph node. I am 4 years out since diagnosis and doing great. my last CT scan was NED. Only lasting side effect is dryness on right side of throat at night when i sleep and occasionally a slight cramp pops up in my neck on right side. Other than that life is back to normal. My rads Dr. at Mayo clinic said chemo wouldn't be needed and that he could "kill" the cancer with just rads. I was early stage N1T2. treatment was very "bearable" and the pain/discomfort only hit about a 5 out of 10. The most difficult part for me was my neck got really burned and sensitive towards the end of treatment and a week or so beyond. I did lose 42 pounds but I needed to lose some weight. Taste came back to 100% about 4 weeks after treatment. I would highly recommend proton therapy if available. Good luck. You can do this!