Cancer

"The use of chemotherapy to treat patients with incurable metastatic or recurrent HNSCC is well established. The median survival for these patients is approximately 6 months, and chemotherapy has had little impact on overall survival. The goal of this treatment is the palliation of cancer-related symptoms attributable to a reduction in tumor burden."

Everett E. Yokes

"Previously treated cancer responds much differently than naive tumors, and unresectable tumors may respond differently than resectable tumors."

Ernest A. Weymuller, Jr.

"Researchers still struggle to demonstrate a clear survival benefit, but the secondary goal of preserving function of the larynx and pharynx without compromising survival can now be successfully achieved."

K. Thomas Robbins

Over the past 20 years, there has been a gradual evolution in the treatments offered to patients with head and neck squamous cell cancer (HNSCC). Although 60 to 80% of patients with early-stage I and II HNSCC can be cured with surgery and/or radiation therapy, the cure rate falls to 30% or less for patients with locally advanced stage III and IV disease. Local and regional relapse accounts for most of the failures observed in patients treated with surgery and radiation therapy. A few patients experience distant tumor spread. Chemotherapy, historically used for palliation in patients with recurrent and/or metastatic disease, has been investigated in several experimental multimodality primary treatment regimens. These investigations have attempted to improve survival, locoregional control, and organ preservation. Distant failure rates and quality of life have also been evaluated. Although surgery and radiotherapy are the most accepted primary treatments for patients with locally advanced HNSCC, recent literature, including meta-analyses of randomized studies, suggests that concomitant chemo- and radiotherapy, with or without surgery, has become the new standard. This chapter briefly reviews the traditional role of chemotherapy for the palliation of recurrent and/or metastatic disease and then describes the recent studies that show a role for chemotherapy in the frontline treatment of patients with locally advanced disease.

TABLE 7-1

Single Chemotherapeutic Agents with Activity in Head and Neck Squamous Cell Cancer

TABLE 7-1

Single Chemotherapeutic Agents with Activity in Head and Neck Squamous Cell Cancer

Chemotherapy

Pooled Response Rate (%)a

Methotrexate

31

Cisplatin

28

Carboplatin

22

Bleomycin

21

Paclitaxel

40

Docetaxel

31

5-Fluorouracil

15

Ifosfamide

26

Topotecan

22

Vinorelbine

22

Gemcitabine

13

a Includes both complete remission (CR) and partial remission (PR).

a Includes both complete remission (CR) and partial remission (PR).

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