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 tumours 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
Index: Clinical Practice Guidelines for Oropharyngeal Cancer
Resource Appropriate Oropharyngeal Cancer Guideline Scenarios
African Head & Neck Society (AfHNS) Clinical Practice Guidelines for Head & Neck Cancers in Developing Countries and Limited Resource Settings 