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6.9.15: 15. Treatment Modifications in Poorly Resourced Settings

  • Page ID
    53892
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    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