[Neoadjuvant chemotherapy of head and neck cancer]

Chemotherapy for head and neck cancer has made great progress after CDDP was introduced at the clinical level. Chemotherapy prior to regional treatment (neoadjuvant chemotherapy) has become a popular approach for incorporating chemotherapy into multimodality treatment. Numerous studies support the general observation that response rates, especially the rates for complete response, are higher in patients who have not had prior regional treatment. The goals of this treatment are 1) to increase the effectiveness of local treatment (surgery and radiation therapy) while obtaining superior disease-free survival, and 2) to prevent metastases by eradicating micrometastatic lesions. Despite the excellent response rates after reported for regimens with CDDP, randomized studies have failed to prove statistically significant superior disease-free survival. The reason for these negative results is considered to be the patient's compliance and difficult of obtaining sufficient numbers of patients in each kind of primary sites, because this type of cancer is relatively infrequent. More study of neoadjuvant chemotherapy with high quality control is needed. Some trials with neoadjuvant chemotherapy to preserve the function of larynx or hypopharynx are promising new strategies. Concurrent chemo-radiotherapy using CDDP was proved to potentiate radiotherapy and showed a good response rate. Adjuvant chemotherapy after surgery or radiotherapy is also expected to prolong disease-free survival when it is incorporated into multimodality treatment.