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6.6.9: 9. Treatment Modifications in Poorly Resourced Settings

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

    • Expense
    • Morbidity e.g. >25% risk of hypothyroidism from radiating central neck, 80% if radiation after thyroid lobectomy
    • Social support and likelihood to complete treatment
    • Competing institutional needs for scarce radiation therapy

    Primary chemoradiation: when weighing up need with marginal indications, consider:

    • Patient’s fitness/ finances
    • Morbidity and mortality related to treatment
    • Social support and likelihood to complete treatment
    • Institutional package of care

    Unavailability of postoperative radiation therapy (PORT)

    • Patients with T4 malignancy normally receive PORT (Indications for PORT)
    • Consider who not to offer surgery for advanced tumours when outcomes without PORT will be poor (palliate)
    • Not having PORT to treat residual microscopic cancer or nodal metastases has the following surgical implications:
      • Wider tumour resection margins
      • More likely to require a flap to reconstruct the pharynx
      • Low threshold to convert a selective neck dissection to modified neck dissection/ extended ND (level VI)