Oropharyngeal cancer: 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
  • 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