options.

Dr. Lydiatt said "The good news is we have lots of options... And the bad news is we have lots of options." (It is good that between Mike and Dr. Lydiatt we share moments of laughter because this is weighty stuff. My chest feels tight today writing about it.) Some of our options include: RADIATION & CHEMOTHERAPY Most data in the Head & Neck field is in the radiation arena which is why you hear so much about it. This is in fact the recommendation of the Tumor Board at UNMC for Mike. It is their "gold standard" treatment because it kills the cancer and has high cure rates. But even Dr. Lydiatt admitted that he is worried (as are we!) about the long-term toxicity of this gold standard treatment. Traditionally this was a cancer of a demographic of much older smokers, chewers and folks with poor dental health. Mike represents a new demographic of young, healthy non-smokers who would be affected by the effects of radiation & chemo 10-15 years down the road when he will still be relatively young RADIATION & CETUXIMINAB Dr. Lydiatt said that he actually favors a treatment of radiation with an antibody called Cetuximinab. This particular antibody adheres to the EGFRs (epidermal growth factor receptors) and improves the effects of the radiation. SURGERY AS PRIMARY TREATMENT Mike and I have liked this option from the git-go. Even Dr. Lydiatt said that "surgery has a role to play that we are not using enough." Surgical removal reduces the cancer load and would lower the radiation dose needed. (Our desire would be to have little or no radiation but we have to balance the known effectiveness of radiation's ability to kill cancer, especially since it has already strayed to Mike's lymph nodes.) One of our favorite things to read is one of Dr. Bruce Haughey's papers entitled "Transoral Laser Microsurgery as Primary Treatment for Advanced-Stage Oropharyngeal Cancer". He basically says that this kind of surgery for Mike's kind of cancer have had successful results - but you can read it for yourself! This is the route we hope to take. Please pray for Dr. Haughey as he speaks in New Zealand on Mike's kind of cancer, for his safe trip back to the States, and for wisdom as he sets up his schedule with Mike. Transoral Laser Microsurgery as Primary Treatment for Advanced Stage Oropharyngeal Cancer: A United States Multicenter Study Haughey BH, Hinni ML, Salassa JR, Hayden RE, Grant DG, Rich JT, Milov S, Lewis JS Jr, Krishna M. Department of Otolaryngology-head and Neck Surgery Washington University School of Medicine, St. Louis, Missouri Abstract BACKGROUND: Nonsurgical modalities are sometimes advocated as the standard of care for advanced oropharyngeal tumors. Oncologic and functional results have been modest. The aim of our study was to evaluate outcomes of a minimally invasive approach, using transoral laser microsurgery (TLM) as the primary treatment for advanced oropharyngeal carcinoma. METHODS: A prospectively assembled database of 204 patients with American Joint Committee on Cancer (AJCC) stages III and IV tonsil or tongue base cancer, treated primarily with TLM during 1996-2006 at 3 centers with minimum 2-year follow-up were analyzed. Survival, locoregional control, and swallowing status were recorded. RESULTS: Mean follow-up was 49 months and 79.4% of patients were alive. Three-year overall survival, disease-specific survival, and disease-free survival were 86%, 88% and 82% respectively. Local control was 97%, and 87% of patients had normal swallowing or episodic dysphagia. CONCLUSIONS: TLM as a primary treatment for advanced oropharyngeal malignancy confers excellent survival and swallowing proficiency.