Perspectives on Chemotherapy of Head and Neck Cancer

Conventional chemotherapy in head and neck cancer is confined to advanced recurrent disease not amenable to surgery or irradiation. The last decade has seen the development of combination chemotherapy programs resulting in improved response rates and the achievement of more complete clinical remissions, although overall survival has not been extended. These same treatments have demonstrated higher regression rates in untreated patients and a survival benefit for the complete responders to induction or neoadjuvant therapy. Neoadjuvant treatment appears to have an important role in laryngeal preservation resulting in improved quality of life. For patients with unresectable cancers of the head and neck, concomitant chemotherapy and radiation gives some survival advantage, albeit with an increase in toxicity. The incidence of these neoplasms may be capable of being decreased with biologic modifiers in some high-risk populations.