There were three issues for the UNMC Tumor Board:
1. Radiation + Chemotherapy: Everyone agrees that the 3-5% edge (probably smaller) is a dealer's choice with a p16 consideration. They agreed to let us opt out of their recommendation for chemotherapy AFTER radiation.
2. One Side or Both Sides: The board agreed that it is reasonable to NOT radiate the right side of Mike's neck with the left side.
3. Using a Lower Dosage: This is where Dr. Zhen and the board did not feel comfortable. 66 is the standard lower dose at UNMC and we asked for 60. We heard Dr. Zhen and the board say that they were not comfortable with 50-55 which were numbers that Dr. Haughey uses in his research because they fear it might fail to kill the cancer.
After hearing the tumor board's recommendations I had to call Dr. Ken Zhen and find out what number he was comfortable with. He wasn't comfortable with 50-55 and we weren't comfortable with 66. After some discussion Dr. Zhen agreed to 60 grey maximum, but said that he would want to treat Mike's entire neck area / surgical bed and not just target the affected lymph nodes and areas immediately surrounding.
So I made another call to St. Louis where I talked with radiation oncologist Dr. Wade Thorstad. You have no idea how much I appreciate his kind, wise and caring counsel. The bottom line is that Dr. Haughey and Dr. Thorstad are pioneers in their field and their numbers will probably be the standard for p16 positive cases in about 10 years. For now the bulk of the cancer community feels comfortable using old clinical trials even though they don't reflect the unique behavior of the p16 cancer. Dr. Thorstad said that without a CT scan taken before Mike's second surgery, he would create a treatment plan similar to Dr. Zhen's (targeting of larger neck area) because he would not have the "map" to localize the treatment area.
This was the last piece of this puzzle.
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