6.9.15: 15. Treatment Modifications in Poorly Resourced Settings
- Page ID
- 53892
\( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \) \( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)\(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\) \(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\)\(\newcommand{\AA}{\unicode[.8,0]{x212B}}\)
Oropharyngeal cancer: Treatment modifications in poorly resourced settings
Inability to stage cancers due to unavailability P16 testing: “Is AJCC/UICC Staging Still Appropriate for Head and Neck Cancers in Developing Countries?”
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 of completing treatment
- Competing institutional needs for radiation therapy or for operating time
Platinum-based adjuvant chemotherapy: when weighing up need with marginal indications, consider:
- Patient’s fitness
- Morbidity and mortality related to treatment
- Social support and likelihood of completing treatment
- Only 4% lifetime survival advantage with addition of chemotherapy to radiation therapy in an adjuvant setting
Unavailability of postoperative radiation therapy (PORT)
- Most patients with T3/T4 malignancies normally receive PORT (Indications for PORT)
- Consider who not to offer surgery for advanced tumors when outcomes without PORT will be poor
- Not having PORT to treat residual microscopic cancer or nodal metastases has the following surgical implications:
- Wider than usual tumour resection margins
- Low threshold to convert a selective neck dissection to modified neck dissection