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