A multidisciplinary approach to squamous cell carcinomas of the head and neck: an update

The treatment of locally advanced squamous cell carcinoma of the head and neck has improved with the addition of chemotherapy to radiotherapy. Other approaches are being investigated to improve the clinical benefit at an acceptable level of toxicity.

The present review summarizes recently published data on the treatment of locally advanced squamous cell carcinoma of the head and neck. Altered radiation fractionation regimens have been shown to increase efficacy, and induction chemotherapy may offer clinical benefits. One of the most important advances in this setting has been the demonstration that addition of the epidermal growth factor receptor-targeted monoclonal antibody, cetuximab, to radiotherapy improves locoregional control and overall survival compared with radiotherapy alone. The survival benefit of this combination appears to be of at least the same magnitude as that seen with chemoradiotherapy, but the combination is not associated with the high level of toxicity that characterizes chemoradiotherapy. The use of more sensitive instruments for adverse event recording may provide a better picture of the toxicity burden.

Although the further modification of radiotherapy and chemotherapy within chemoradiotherapy regimens is unlikely to offer major clinical benefits, it is likely that any significant advances will be made with the incorporation of novel agents into treatment regimens. The combination of cetuximab and radiotherapy forms a new standard for the treatment of locally advanced squamous cell carcinoma of the head and neck.