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6.6.14: 14. Requirements for Effective Delivery of Primary Chemoradiation

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    • Primary CRT is an option mainly for selected T3 supraglottic cancers
      • Not excessively bulky
      • No cartilage destruction
    • Patient factors
      • Functional larynx: airway, swallowing, aspiration
      • Likely to complete CRT treatment
        • Fitness, age
        • Social support / financial means
      • Ability to cope with possible sequelae of CRT
        • Aspiration
        • Dysphagia
        • Renal failure
        • Hearing loss/ peripheral neuropathy
        • Tracheostomy
        • Hypothyroidism
    • Total laryngectomy often a better option in low resource environments because CRT
      • Complex, sophisticated, toxic treatment
      • Requires complex supportive care, both during and following treatment
    • Required package of care for favourable outcomes
      • CT/MRI/PET imaging for planning and surveillance
      • Modern radiation techniques
      • Medical and social support during treatment
      • Speech and swallowing therapy
      • Access to PEG feeding (Short and/or long-term)
      • Cancer surveillance (MRI / PET)
      • Thyroid replacement therapy
      • Complex salvage surgery including pedicled and free flaps