title: Is there still a role for induction chemotherapy in locally advanced head and neck cancer?
abstract: OBJECTIVE
  Despite decades of research, the role of induction chemotherapy (ICT) in the treatment of locally advanced head and neck squamous cell carcinoma remains controversial. When nonsurgical approaches are preferred, chemoradiation (CRT) is the standard of care. However, ICT continues to be investigated, as it can cytoreduce tumors, improve radiotherapy feasibility and tolerability, select patients for organ preservation with radiation, and decrease the risk of distant metastasis.
  
  
  RESULTS
  Herein, we review the recent randomized trials that investigated the role of taxanes in ICT, compared with surgery or CRT alone. A metaanalysis of older trials comparing taxane-containing ICT to cisplatin and 5-fluorouracil is discussed. In addition, long-term results from Radiation Therapy Oncology Group 91-11, a three-arm trial of larynx preservation approaches, are discussed, as well as a recent trial of sequential CRT for larynx preservation. As in previous randomized trials, no survival benefit for ICT was demonstrated. However, two studies showed a reduced risk of distant metastasis in advanced nodal stage patients. As regards larynx preservation, ICT followed by radiation alone in responders to chemotherapy remains an effective option.
  
  
  CONCLUSIONS
  ICT is still controversial and in general, should remain investigational. An exception may be its use in a larynx preservation approach, albeit with a lower crude larynx preservation rate compared with CRT. The results of recent trials provide rationale and support hypothesis generation for future research, which should focus on subsets of patients most likely to benefit, for example, high nodal stage. It will be critical to study human papillomavirus (HPV)-associated oropharynx cancer separately or, at least, stratify by HPV status given its influence on prognosis and attendant implications for statistical design.
authors.affiliation: aDepartment of Thoracic/Head and Neck Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA bMedical Oncology, Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
authors.forename: Milena P
authors.initials: MP
authors.lastname: Mak
authors.forename: Bonnie S
authors.initials: BS
authors.lastname: Glisson
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction / Q000379:methods; D000077195:Squamous Cell Carcinoma of Head and Neck
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin; D005472:Fluorouracil