Treatment modifications of oral 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
  • 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

Index: Clinical Practice Guidelines for Oral Cancer

Resource Appropriate Oral Cancer Guideline Scenarios