[Neoadjuvant chemotherapy in head and neck cancer]

Head and neck cancer represent 5% of all cancer and is often diagnosed at advanced stage. Treatment requires a multidisciplinary approach and relies on surgery, radiotherapy and/or chemotherapy. In locally advanced disease, chemotherapy has been shown to improve survival, particularly when delivered concomitantly with radiotherapy (6.5% absolute benefit in overall survival. Although induction or neoadjuvant chemotherapy has been much studied, no clear benefit has been identified but for larynx preservation. New chemotherapy regimens with adjonction of taxanes have drawn attention again on induction chemotherapy. Several randomised controlled trials have demonstrated improved response rate, disease free survival, or overall survival when docetaxel is added to cisplatin and 5 FU as induction chemotherapy. A definitive proof of the benefit of the induction approach is still lacking. To date, induction chemotherapy can only be recommended with the aim of preserving laryngeal function. Ongoing trials are expected to validate or rule out the induction strategy as a standard approach in locally advanced head and neck cancer.