title: Current management of locally advanced head and neck cancer: the combination of chemotherapy with locoregional treatments.
abstract: This review will discuss the evolution of the role of chemotherapy in the treatment of locally advanced head and neck cancer (HNC), over the last few decades. Studies were identified by searching PubMed electronic databases. Surgery followed by radiotherapy (RT) or definitive RT are potentially curative approaches for locally advanced HNC. While chemotherapy itself is not curative, it can improve cure rates when given as an adjunct to RT. The benefit of combining chemotherapy with RT is related to the timing of the chemotherapy. Several prospective randomized trials have demonstrated that concurrent delivery of chemotherapy and RT (CRT) is the most promising approach, given that locoregional recurrence is the leading pattern of failure for patients with locally advanced HNC. Induction chemotherapy before CRT has not been shown to be superior to CRT alone and the added toxicity may negatively impact the compliance with CRT. Sequential chemotherapy administration, in the form of induction chemotherapy followed by RT or CRT, has been successful as a strategy for organ preservation in patients with potentially resectable laryngeal and hypopharyngeal cancer. Systemic chemotherapy delivered concurrently with RT is used as a standard treatment for locally advanced HNC.
authors.affiliation: Department of Radiation Oncology, Kimmel Cancer Center and Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA. Electronic address: voichita.bar-ad@jeffersonhospital.org.
authors.forename: Voichita
authors.initials: V
authors.lastname: Bar-Ad
authors.affiliation: Department of Radiation Oncology, Kimmel Cancer Center and Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Palmer
authors.affiliation: Department of Medical Oncology, Kimmel Cancer Center and Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
authors.forename: Hushan
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Otolaryngology, Kimmel Cancer Center and Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
authors.forename: David
authors.initials: D
authors.lastname: Cognetti
authors.affiliation: Department of Otolaryngology, Kimmel Cancer Center and Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Curry
authors.affiliation: Department of Otolaryngology, Kimmel Cancer Center and Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
authors.forename: Adam
authors.initials: A
authors.lastname: Luginbuhl
authors.affiliation: Department of Pathology, Kimmel Cancer Center and Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
authors.forename: Madalina
authors.initials: M
authors.lastname: Tuluc
authors.affiliation: Department of Medical Oncology, Kimmel Cancer Center and Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Campling
authors.affiliation: Department of Medical Oncology, Kimmel Cancer Center and Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
authors.forename: Rita
authors.initials: R
authors.lastname: Axelrod
mesh_terms: D059248:Chemoradiotherapy; D019468:Disease Management; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans