Chemotherapy strategies in squamous cell carcinoma of the head and neck

Traditionally, chemotherapy has been utilized in the palliation of patients with recurrent or metastatic squamous cell carcinoma of the head and neck. The introduction of more effective agents has spawned many new multi-drug protocols as the initial therapy of patients with previously untreated advanced cancers (Stages III and IV). The combination of cis-platinum and other active agents given in two to three courses has produced overall response rates of 80 to 90% with clinically complete response rates of 20 to 54%. Many of the complete responders were histologically negative for cancer at the time of resection. The number of courses, stage (T and N), and tumor morphology influenced the complete response rate to combination chemotherapy. Responders to chemotherapy had statistically improved survival as compared to nonresponders. Response to chemotherapy was an excellent predictor for subsequent response to radiotherapy. Utilizing the same combination of chemotherapy, we improved the overall response rate in those patients with recurrent and systemic cancer. Although the median survival is still poor, there is improvement of survival at 25 percentile level. Some of the important factors that may influence the response rate and the survival of these patients are performance status, previous radiotherapy, and whether the recurrence is localized or systemic.