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6.8.10: 10. Treatment Modifications in Poorly Resourced Settings

  • Page ID
    18412
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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
    • 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