[Multidisciplinary treatment for organ/function preservation in head and neck cancer]

Neo-adjuvant chemotherapy (NAC) improved quality of life for surviving patients by providing effective organ/function preservation. Regrettably, however, many randomized trials did not show that NAC significantly improved survival. Many design limitations of these trials make it impossible to draw definitive conclusion. So neo-adjuvant trials should investigate the issue of optimal number of chemotherapy cycles on response (clinical/histologic) and on survival. Future work also should study the integration of biologic response modifiers, differentiation agents, other cytotoxic agents and irradiation into primary therapy. Concomitant chemoradiotherapy is the only approach in this category that has shown potential by increasing survival in randomized studies. This survival benefit has appeared in trials in both resectable and unresectable head and neck squamous cell carcinoma. Recent data from numerous phase II study trials supported the promise of concurrent cisplatin (including carboplatin) and radiotherapy. All the positive single-agent concomitant trials used suboptimal doses of active drugs like BLM, MTX etc, and full doses of relatively inactive drugs like MMC. This indicates that chemotherapy enhances radiotherapy. Recent date from numerous phase II trials now support the promise of concurrent cisplatin (or carboplatin)/radiotherapy. The lack of overlapping toxicities allows optimal administration of both modalities. Concomitant multi-agent chemoradiotherapy began as a result of positive studies with concomitant single-agent chemoradiotherapy. But, this combined therapy increased acute toxicity. Nevertheless, early results from the randomized trials are encouraging, with survival favoring the concomitant arm. The future trials will be required more patients, longer follow-ups and careful assessments of toxicity and quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)