After a multidisciplinary meeting attended by surgeons and oncologists, Mr Nelson had a biopsy carried out.
This was because the growth of the tumour was very rapid, and the clinicians felt that it would recur while the wound healed sufficiently to allow radiotherapy to start.
The clinical team felt that the benefits of an aggressive surgical approach were unlikely to benefit.
Mr Nelson continued with a course of chemo and radiotherapy.
Treatment outcomes and management were extensively discussed with the couple and he responded well and showed no evidence of progression.
In February 2010, Mr Nelson's wife sought further treatment.
A scan confirmed that the treatment given by the NHS had reduced the tumour by 50% and also the swelling round the tumour.
A second opinion was also offered within the NHS, however Mr Nelson was keen to seek private surgery and opinion.
There is no proven evidence that surgery in this setting is beneficial.
Mr Nelson was seen privately in March 2010.
The Dublin team agreed that the treatment Mr Nelson had received in the Royal had been in keeping with accepted evidence.
They noted the improvement in the patient's scan and suggested continuing his treatment.
However they suggested that following the treatment they would consider surgery.
They stated there would be additional surgical risks attached to the procedure.
Thus the surgery that was carried out had, by the clinical team's own admission, no evidence for it.
There is of course the element of patient choice. In these circumstances most doctors will, as in this case, ensure that the patient is carefully counselled regarding the pros and cons.
We are pleased that Mr Nelson is doing well.