6.5.9: 9. Treatment Modifications in Poorly Resourced Settings

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)

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