The role of systemic treatment before, during, and after definitive treatment

In locoregionally advanced head and neck squamous cell carcinomas, outcomes using single-modality therapy are usually poor. Although chemotherapy alone is not considered a curative therapy, the addition of chemotherapy to other modalities can lead to improved outcomes. Discussed here is the use of chemotherapy for oropharyngeal and/or oral cavity squamous cell carcinomas in 3 settings: in combination with radiation as definitive therapy, as induction treatment before definitive therapy, and in combination with radiation therapy as adjuvant treatment following surgical resection. The role of the targeted agent cetuximab in combination with radiation therapy for locally advanced disease is also discussed.