6.6.9: 9. Treatment Modifications in Poorly Resourced Settings
- Page ID
- 18368
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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)