Aggressive Concurrent Chemoradiotherapy for Squamous Cell Head and Neck Cancer

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Abstract
STANDARD THERAPY for advanced head and neck cancer consists of a combination of surgery and radiation therapy; however, survival for this patient population has not improved during the past 20 years. In general 5-year survival for stage III and IV disease is less than 50%, with most patients dying of their disease.1,2 Chemotherapy, while not a curative modality in the treatment of head and neck cancer, has the potential to improve locoregional control, reduce distant metastases, and improve survival. Many different multimodality treatment schedules have been proposed over the years, using chemotherapy before (neoadjuvant), with (synchronous), or after (adjuvant) conventional therapy.3 Recently, another end point for multimodality treatment has been identified: organ preservation. This potential for organ preservation was suggested by the Veterans Affairs Laryngeal Cancer Study Group, which showed that, without compromising survival, laryngeal preservation was possible in approximately two thirds of patients with advanced laryngeal cancers.4 With all of these benefits, clinicians have attempted to develop treatment regimens that might optimize the chemotherapy and radiation combination and, in the event of a complete response, avoid surgery at the primary site.

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