Three decades of investigation have led to a gradual change in the treatments offered to patients with HNSCC. Whereas single modality surgery or radiation, or both, may cure most patients with early-stage disease, patients with locoregionally advanced disease require more aggressive multimodality treatment. Recent analyses show a significant role for the use of concomitant chemo- and radiotherapy in the initial treatment of locally advanced HNSCC. Further investigations are required to define the best treatment protocol.



Gordon and Vokes—CHAPTER


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The Role of Chemotherapy in Head and Neck Cancer

Douglas B. Villaret and Ernest A. Weymuller, Jr.

The addition of chemotherapy to the treatment of advanced head and neck cancer is a controversial subject, with vocal opponents and proponents. Clinical trials have been devised to elucidate the role of treating squamous cell carcinoma in the head and neck with chemotherapeutic drugs. There are many difficulties, however, in interpreting the results from these studies: (1) the heterogeneous sites of the head and neck seem to respond differently to similar treatments; (2) the effectiveness of a drug depends not only on its intrinsic properties, but also on the dose used, the schedule in which it is delivered, and the subsites treated; duplication of all these events is difficult, hence the limited number of corroboratory studies; (3) drugs are often used in combination to take advantage of the different modes of action, with widely diverse combinations; (4) previously treated cancer responds much differently than naive tumors, and nonresectable tumors may respond differently than resectable tumors; (5) patients themselves vary widely and should be stratified according to well-known criteria, such as performance, alcohol, and nutritional status; and (6) many trials are not randomized, making their evaluation difficult, as even prospective studies must then use historical controls, which may or may not be relevant.

This chapter collates some of the data and presents a case for the use of chemotherapy for the management of squamous cell carcinoma in certain clinical settings.

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