Intermediate risk

I am still very much struggling to make a decision about whether to have the adjuvant radiotherapy. There are so many reasons not to have it, but also some very important ones in favour of it. I went to see my oncologist today to go through my pathology report in detail with her, hoping it would help me make my decision. We went over the tumour size, the margins, and the neck nodes. The report showed that I didn’t have any perineural or vascular invasion. All of these factors are in my favour. I asked her what she would advise if she were treating a member of her family. She said they weren’t allowed to advise on that basis, but what she could do was take me through which group I would fall into in a trial that is currently being run internationally. 

The PATHOS trial is looking at less intensive treatment after surgery for hpv-positive oropharyngeal cancer. It is supported by Cancer Research UK. It is part of a move towards trying to reduce the intensity of treatment for HPV-positive head and neck cancers to reduce the chance of side effects. To date, no one has collected data in the right way after surgery to be able to know whether or not this is the best thing to do, so PATHOS is looking to do this so that we know for sure that side effects can be reduced without reducing the chance of curing the tumour. The outcome of this trial will obviously be far too late to help me, but it’s great to know something is being done to try to minimise the radiotherapy side effects, because they do sound horrific. 

Back to my own situation, because my tumour was stage 2, it meant the margins were close (clean but close). Were I participating in the trial, I would be classed as ‘intermediate risk’ and would be given adjuvant radiotherapy. This sealed the deal in my mind. Had I been low risk, I would have declined the radiotherapy, but intermediate feels too risky. The radiotherapy decreases the chance of recurrence by up 10% making my chance of it coming back even smaller, so I am going to go for it.

Yikes.