Combined-modality therapy for head and neck cancer

Chemotherapy, when combined with radiotherapy and/or surgery in the treatment of patients with head and neck cancer, appears to be most efficacious if it is given concurrently with radiotherapy. Concurrent chemotherapy and radiotherapy has been shown to improve locoregional control and/or disease-free or overall survival in some randomized trials. However, acute mucositis is usually increased with simultaneous drug and radiation administration, especially when more than one drug is given concurrently with radiotherapy. The optimal drug or drug combinations for use in combined-modality therapy and the optimal drug and radiation dose schedules remain to be determined. Alternating radiotherapy and combination chemotherapy may also be beneficial and needs further evaluation. Induction chemotherapy followed by definitive radiotherapy in the chemotherapy responders is an alternative treatment option for patients with locally advanced, resectable squamous cell carcinoma of the larynx or hypopharynx who desire organ function preservation. Induction and/or adjuvant chemotherapy may also decrease or delay the appearance of distant metastasis. However, induction chemotherapy has not been shown to improve locoregional control or overall survival. Further clinical trials using novel drugs, innovative radiation and drug dose schedules, and other treatment modifiers are needed to improve the therapeutic ratio.