Cisplatin combinations in the treatment of head and neck cancer

Most patients with head and neck cancers present with locally advanced (stages III and IV) disease. The conventional treatments for these patients are surgery and/or radiotherapy, and the overall results in resectable or unresectable disease are poor and unacceptable. Most of the patients have locoregionally recurrent disease. These poor results led to the investigation of systemic chemotherapy as part of the combined modality treatment for patients with locally advanced head and neck cancers. The achievements of systemic chemotherapy are summarized herein. For instance, active agent(s) and combinations have been identified, as have prognostic factors that influence response rates (overall and complete), and overall results in previously untreated patients. Identification of timing and sequence of chemotherapy as part of combined modality treatment, especially in patients with resectable cancer, has become feasible. Also possible is the prediction of response to subsequent radiotherapy after response to initial induction chemotherapy. This article also discusses the results obtained with concurrent high-dose cisplatin and radiotherapy as total treatment for patients with nasopharyngeal carcinomas and other patients with inoperable and unresectable cancer or in postoperative patients. Results of systemic chemotherapy in laryngeal function preservation is also summarized. Results are also obtained in unresectable patients and organ preservation with induction chemotherapy followed by concurrent chemoradiotherapy. Improved treatment of systemic metastasis and/or survival with maintenance chemotherapy are goals of current trials. We found a decreased incidence of systemic recurrence to be possible with induction and postsurgery chemotherapy. Continued studies are necessary to further improve prognoses in the treatment of head and neck cancers.