Cisplatin plus radiation therapy

Advanced-stage squamous cell cancer of the head and neck remains a difficult therapeutic dilemma despite aggressive use of surgery and radiation therapy. The majority of patients still relapse with locoregional disease. Distant metastases are a frequent cause of failure in patients where local disease is controlled. Neoadjuvant chemotherapy reduces the incidence of distant metastasis, but despite the promise generated by a high objective response rate, does not alter the frequency of local recurrence or improve patient survival. The concomitant use of chemotherapy and radiation therapy has the theoretical advantage of radiosensitization with improved local control, preservation of the systemic effect of neoadjuvant treatment, and reduction in the total treatment time. Clinical trials conducted using cisplatin alone or in combination with 5-fluorouracil strongly suggest that this local control advantage is achieved. But randomized studies, convincingly demonstrating that the increased toxicity observed with most concomitant programs is justified by increased patient survival compared with radiation therapy alone, have yet to be completed. Future trials will need to evaluate the impact of cisplatin dose and route of administration. The incorporation into concomitant treatment programs of new agents recently demonstrated as active in head and neck cancer also deserves aggressive clinical investigation.