Treatment modifications of glottic cancer 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)

Index: Clinical Practice Guidelines for Glottic Cancer

Resource Appropriate Glottic Cancer Guideline Scenarios