Discussion

Patients with metastatic disease should receive chemotherapy in an effort to reduce the symptoms of the disease. Cure is not a realistic goal, and the prolongation of survival is frequently no more than a few months. Although several agents have been shown to reduce tumor burden, there is no single clear standard regimen. Combination cisplatin and 5-FU can lead to greater tumor responses at the price of increased toxicity. Therefore, this regimen should be reserved for patients with adequate performance. Whenever possible, patients should be referred for enrollment in ongoing clinical trials of newer agents and schedules.

The treatment of locally advanced HNSCC is an area of active clinical investigation. Treatment should be given with curative intent. Several studies and three meta-analyses indicate that patients with locally advanced disease benefit from initial treatment with concomitant chemo- and radiotherapy. The best specific treatment protocol has not yet been identified. Therefore, whenever possible, patients with locally advanced HNSCC should be referred for treatment on clinical trials. If a patient with locally advanced

OPTIMAL STAGING Head and Neck CT Scan Bronchoscopy Esophagoscopy Nasopharyngoscopy Chest Xray or CT chest Bone Scan (Optional)

Figure 7-1 University of Chicago treatment algorithm for patients with head and neck squamous cell carcinoma. *Patients with early stage unresectable tumors (i.e., base-of-tongue cancers) may benefit from treatment with concomitant chemo- and radiotherapy (chemoradiotherapy).

HNSCC cannot be referred for an investigational protocol, treatment may be given by a multidisciplinary team according to one of the larger randomized regimens of concomitant chemo-and radiotherapy. In cases of locally advanced disease, surgery should be performed either for salvage of persistent disease after chemoradiotherapy or for modified neck dissection after chemo-radiotherapy in patients with initial bulky lymphadenopathy (N2-N3 disease). The University of Chicago general algorithm for the treatment oflocally advanced disease is illustrated in Figure 7-1.

0 0

Post a comment