Intensive Chemoradiotherapy as a Primary Treatment for Organ Preservation in Patients With Advanced Cancer of the Head and Neck

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Abstract
As an alternative to surgical resection, the integration of chemotherapy and radiotherapy is currently being investigated as a viable treatment option for organ preservation in patients with advanced squamous cell carcinoma of the head and neck. Organ preservation strategies include 2 regimens of chemotherapy and radiotherapy, sequentially or concurrently.1 The sequential regimen, which includes induction chemotherapy followed by definitive irradiation for responders, has been tested in 2 large randomized trials, one for patients with laryngeal cancer2 and the other for patients with hypopharyngeal cancer.3 These 2 phase 3 trials demonstrated that sequential chemotherapy and radiotherapy yielded survival rates similar to those obtained by surgery and irradiation but with organ preservation in many patients. The response to chemotherapy is highly predictive of the response to radiotherapy, and, therefore, it is used to select patients for treatment by either surgery or irradiation. Despite a slightly lower rate of distant metastasis, this approach showed no improvement in locoregional control or survival.

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