The community approach to salvage therapy for advanced head and neck cancer

The natural history of squamous cell head and neck cancer is well understood. Locoregional approaches to salvage therapy for this disease have curative potential, primarily because distant metastases are uncommon. Before proceeding with salvage treatment, however, clinicians should identify the extent of disease and determine whether the treatment intent is curative or palliative. Because of the associated morbidity, surgery should be considered only in patients for whom cure of recurrent disease is feasible. Radiation therapy may be indicated in patients whose disease recurs after surgery and in selected patients in whom initial radiation has failed. Single-agent and combination chemotherapy, in particular the combination of cisplatin and 5-fluorouracil, has achieved overall response rates of 30% to 40% in patients with recurrent disease. However, cure after salvage chemotherapy has not been achieved. Until salvage treatment regimens capable of achieving significant long-term survival are identified, symptomatic palliation will remain the main treatment goal in this patient population.