[Organ sparing treatment modalities - which type of treatment for which carcinoma?]

Radical surgery followed by postoperative radiotherapy is still the most effective treatment option for advanced resectable head and neck cancer. It is therefore of utmost importance to determine the resectability before start of the treatment. For those patients who suffer from unresectable cancer or refuse to undergo surgery, alternatives, such as induction-chemotherapy or radiotherapy plus chemotherapy alone may be offered. Historical studies investigating alternative treatment protocols were conducted almost 20 years ago. These studies demonstrated that in approximately 2/3 of all patients with laryngeal and hypopharyngeal cancer undergoing induction-chemotherapy according to the PF-protocol (cisplatin plus 5-FU as a continuous infusion) and subsequent radiotherapy, larynx preservation without negative impact on overall survival could be achieved. At least three randomized studies have shown a clinical advantage for a treatment combination consisting of docetaxel or paclitaxel plus CDDP/5-FU over a historical control regimen containing CDDP/5-FU alone. This novel combination therefore is currently regarded as the gold-standard for induction-chemotherapy in advanced head and neck cancer patients. A further significant addition to the therapeutic armamentarium for the head and neck radiation oncologist is the recently introduced monoclonal antibody cetuximab. It was found in a randomized landmark study that addition of cetuximab to radiotherapy significantly improves local control as well as overall survival of advanced stage head and neck cancer patients. In light of these recent developments this review discusses the role of organ sparing treatment protocols and different levels of evidence with special consideration of tumor localization.