Long-term Quality of Life for Surgical and Nonsurgical Treatment of Head and Neck Cancer

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Abstract
The use of systemic chemotherapy to treat head and neck cancer (HNC) has increased substantially over the last 15 years. The sensitivity of squamous cell carcinoma (SCC) of the upper aerodigestive tract to several chemotherapeutic agents has been clearly demonstrated.1 Chemotherapy has been used in conjunction with radiation therapy in the management of HNC in a variety of schemes, including induction, concurrent, intra-arterial, adjuvant (postdefinitive treatment), and, most recently, concurrent with postoperative radiation therapy.2,3 Intra-arterial chemotherapy has demonstrated efficacy. However, this type of regimen is labor intensive and not routinely available.4 Adjuvant chemotherapy has not demonstrated a survival advantage, but it appears to decrease the incidence of distant metastasis.5 Induction (neoadjuvant) chemotherapy followed by radiation therapy has not been shown to confer a survival advantage.5,6 However, it was through the use of induction chemotherapy in organ preservation studies that the use of chemotherapy and radiation therapy as a curative alternative to surgery and postoperative radiation therapy (SRT) became widely recognized.7 Four large meta-analyses and many individual randomized trials have demonstrated a survival advantage of 8% to 12% in patients with HNC when concurrent chemotherapy is given with radiation therapy (CRT) compared with radiation therapy alone.8-11 These results have defined the most promising role for chemotherapy in the treatment of HNC.

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