Management of advanced stage squamous cell carcinoma of the head and neck

Squamous cell tumors of the head and neck make up 5% of tumors diagnosed in this country. The combination of excessive tobacco and alcohol use is the most common causative factor for these tumors. Their natural history is characterized by a tendency for early local-regional recurrence and the late appearance of distant metastases. A significant proportion of patients present with advanced (stage III or IV) disease, which has a poor prognosis when treated with surgery and radiotherapy. The use of adjuvant chemotherapy with surgery and radiotherapy in previously untreated patients holds promise for improving cure rates in patients with this disease. The use of chemotherapy in patients with recurrent head and neck tumors results in response in approximately one third of patients. The majority of these responses are partial and short-lived, but those patients achieving a complete remission appear to have a significant prolongation of survival. The combination of chemotherapy and radiotherapy in patients with advanced disease is being tested in a number of trials. It is hoped that this combination will increase the response rate and result in prolonged survival.