Preoperative Chemotherapy-Sensitized Radiation Therapy for Cervical Metastases in Head and Neck Cancer

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Abstract
MULTIMODALITY therapy for advanced squamous cell carcinoma of the head and neck has evolved over the past 3 decades. Initial studies used both surgery and radiation therapy and showed a lower local recurrence rate for stage III and stage IV head and neck cancer, with postoperative radiation therapy resulting in a greater decrease in relapse rate.1 Induction chemotherapy was more recently instituted, but when compared with radiation therapy, it did not improve survival significantly.2,3 However, patients who received induction chemotherapy and achieved a complete response did appear to have a better outcome than patients who had less than a complete response.4 With these positive results, many investigators have attempted to treat patients with single or multiple adjuvant chemotherapy regimens or chemotherapy agents combined with sequential preoperative or postoperative radiotherapy.5-7 Many radiosensitizing chemotherapeutic agents have been used, most notably cisplatin.8-11 Other chemotherapy agents include bleomycin sulfate, methotrexate, hydroxyurea, fluorouracil, mitomycin, and carboplatin. While some investigators have evaluated the various chemotherapy modalities, others have examined the role of altered fractionation in radiation therapy, which showed improved local control.12,13

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