Concurrent chemoradiotherapy for head and neck cancer

Concurrent chemoradiotherapy (CRT) has been shown to be superior to radiotherapy (RT) alone in several clinical therapeutic settings for head and neck cancer (HNC). In unresectable disease, CRT is superior to RT alone, and for resectable advanced disease, it may serve as a substitute for initial surgery, with planned salvage surgery as a backup. In the postoperative setting, clinical trials suggest that CRT is superior to RT alone. Recent results of phase II studies suggest that the addition of induction chemotherapy to CRT may further enhance outcome through eradication of systemic metastases, although this will require prospective evaluation in randomized clinical trials. Additionally, chemotherapy given with hyperfractionated RT leads to improved outcome versus hyperfractionated RT alone. The optimal CRT regimen is still a matter of debate and ongoing study.