Greetings, Doctor. I was diagnosed with non-Hodgkin's lymphoma 2 months ago. It was localized in a 6 cm tumor in my neck. I'm on HAART. CD4 450 VL 5000. I'm about to finish my 3rd and final round of CHOP & Rituxan. It has gone very well. After the first dose of Rituxan, the tumor shrunk 1/3 in size in 24 hours. I then had chemo the next day and the tumor was gone 48 hours later. I feel good and strong. My question: One oncologist wants me to do radiation after chemo. Another suggests I consider doing several more rounds of Rituxan instead. Do you have an opinion? Which will ultimately be easier on my immune system? How damaging is radiation to the neck? Might I lose a saliva gland? If it was your body, which would you opt for?

Thanks for your good work.

It is never easy for a patient when s/he gets two opinions and they differ. Both of the treatment plans outlined are reasonable. Since you asked me what I would personally do, I treat my HIV-lymphoma patients with 6 cycles of CHOP-Rituxan, followed by a few more rounds of Rituxan. Some oncologists like to radiate areas of bulky disease to prevent recurrence. Although I personally do not recommend radiation to many of my patients, I can certainly understand why some are recommending it to you. You indeed may have problems with your salivary gland after radiation. In terms of your immune system, both approaches are reasonably safe. I would urge you not to get a third opinion since you could get a third point-of-view which will only leave you more complexed. You will probably do well no matter what path you take.