Current treatments and promising investigations in a multidisciplinary setting

The care of the patient with squamous cell carcinoma of the head and neck (SCCHN) requires a multidisciplinary approach. For many years, radiotherapy following surgery was considered the standard approach to the treatment of locally advanced resectable disease. Data from randomized trials have confirmed the benefits of concurrent chemotherapy and radiotherapy (chemoradiotherapy) in this setting and this is now the gold standard for treatment. Chemoradiotherapy is also the recommended approach for unresectable disease. Neoadjuvant chemotherapy has been useful in resectable disease where organ preservation is desirable, but a concomitant approach is superior. Although survival benefits have not been consistently demonstrated, the theoretical potential of this approach has lead to continued investigations using newer agents, such as the taxanes. Novel targeted agents, such as antagonists of the epidermal growth factor receptor (EGFR), are showing promise in the treatment of patients with both locally advanced and recurrent/metastatic SCCHN. Treatment issues that require immediate attention include identifying optimal chemoradiotherapy regimens, clarifying the role of neoadjuvant chemotherapy, defining the optimal integration of targeted therapies into combined modality approaches and identifying useful prognostic and predictive factors.