Induction chemotherapy: to use or not to use? That is the question

The intensification of radiation, induction chemotherapy, and concomitant chemoradiotherapy has been extensively investigated over the past 2 decades for the nonsurgical management of locally advanced, nonmetastatic squamous cell head and neck cancer (HNC). Concurrent chemoradiation has emerged as the standard of care, with the majority of its benefit resulting from improvements in locoregional disease control. Distant failure has become a more prominent problem in conjunction with these improvements. Concurrent chemotherapy provides suboptimal adjuvant treatment for distant disease. Multiagent induction chemotherapy holds more promise especially with the use of taxane-based regimens. Induction chemotherapy followed by concurrent chemoradiation (sequential chemoradiation) is now under investigation. The rationale and evidence supporting the choice to use or not to use a sequential program are discussed.