Organ preservation protocols in developing countries

Abstract

Conservative surgical procedures, radiotherapy and chemoradiotherapy can all be considered in organ preservation strategies for patients with head and neck squamous cell carcinoma. In spite of the contribution of well designed clinical trials, in clinical practice, especially in developing countries, results are related to variables that were usually not considered in such trials. The results of most organ preservation studies are focused on survival and larynx preservation, but an evaluation of quality of life and function of the organ is still lacking. We performed a systematic search on the MEDLINE database and could not find any such studies conducted in developing countries. In the present review we consider the possible problems associated with the application of organ preservation strategies in developing countries in some critical areas: advanced stage, comorbidities, nutritional status, long distance to travel, availability of chemotherapy and radiotherapy facilities, tolerance, adherence to protocol standards and expertize in performing salvage surgery. Recent publications strongly suggest that chemoradiation should not be indicated in all patients with advanced laryngeal and hypopharyngeal cancer, but that an individualized treatment strategy should be recommended. Organ preservation treatments depend on factors related to the physician and the institutions providing healthcare, and also on patients and health systems and socioeconomic factors that make it impossible to extrapolate these results. Only after a meticulous evaluation of the final results of the application of these protocols in each specific environment can they be recommended for carefully selected patients.