Skip to main content
Medicine LibreTexts

6.8.10: 10. Treatment Modifications in Poorly Resourced Settings

  • Page ID
    18412
  • \( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \) \( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)\(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\) \(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\)\(\newcommand{\AA}{\unicode[.8,0]{x212B}}\)

    Postoperative radiotherapy (PORT): when weighing up need with marginal indications, consider:

    • Expense
    • Morbidity e.g. 25% risk of hypothyroidism from radiating central neck
    • Social support and likelihood to complete treatment
    • Competing institutional needs for scarce radiation therapy

    Platinum based adjuvant therapy: when weighing up need with marginal indications, consider:

    • Patient’s fitness
    • Morbidity and mortality related to treatment
    • Social support and likelihood to complete treatment
    • Only 4% lifetime survival advantage by addition of chemotherapy to radiation therapy in an adjuvant setting

    Unavailability of postoperative radiation therapy (PORT)

    • Most patients with T3 and T4 malignancy normally receive PORT (Indications for PORT)
    • Consider who not to offer surgery for advanced tumours when outcomes without PORT will be poor
    • Not having PORT to treat residual microscopic cancer or nodal metastases has the following surgical implications:
    • Wide tumour resection margins
    • Low threshold to convert a selection neck dissection to modified neck dissection
    • Palliative surgery can be recommended for very select patients