Head and Neck Cancer Treatment

Patients with head and neck cancer can be categorized into three clinical groups: those with localized disease, those with locally or regionally advanced disease, and those with recurrent and/or metastatic disease. Comorbidities associated with tobacco and alcohol abuse can affect treatment outcome.

Localized Disease - Nearly one-third of patients have localized disease; that is, T1 or T2 (stage I or stage II) lesions without detectable lymph node involvement or distant metastases. These lesions are treated with curative intent by surgery or radiation therapy. The choice of modality differs according to institutional expertise. Radiation therapy is often preferred for laryngeal cancer to preserve voice function, and surgery is preferred for small lesions in the oral cavity to avoid the long-term complications of radiation, such as xerostomia and dental decay. Overall 5-year survival is 60 to 90%.

Locally or Regionally Advanced Disease - Locally or regionally advanced disease - disease with a large primary tumor and/or lymph node metastases - can also be treated with curative intent, but not with surgery or radiation therapy alone. Combined modality therapy including surgery, radiation therapy, and chemotherapy is most successful. Concomitant chemotherapy and radiation therapy appears to be most effective.

Head and Neck Cancer
Introduction
Incidence and Epidemiology
Etiology and Genetics
Hostopathology & Carcinogenesis
Differential Diagnosis
Treatment
Chemoprevention
Treatment Complications
Further Reading

INDUCTION CHEMOTHERAPY

In this strategy, patients receive chemotherapy [usually cisplatin and fluorouracil (5FU)] before surgery and radiation therapy. Most patients who receive three cycles show tumor reduction, and the response is clinically "complete" in up to half. This "sequential" multimodality therapy does not cure more patients than surgery plus radiation therapy alone. However, induction chemotherapy allows for organ preservation in patients with laryngeal and hypopharyngeal cancer.

CONCOMITANT CHEMORADIOTHERAPY
With the concomitant strategy, chemotherapy and radiation therapy are given simultaneously rather than sequentially. Because most patients with head and neck cancer develop recurrent disease in the head and neck area, this approach is aimed at killing radiation-resistant cancer cells with chemotherapy. In addition, chemotherapy can enhance cell killing by radiation therapy. Toxicity (mucositis) is increased with concomitant chemoradiotherapy; however, meta-analysis of randomized trials documents an improvement in 5-year survival of 8% with concomitant 5FU and radiation therapy. Results seem even better with 5FU and cisplatin plus radiation therapy. Five-year survival is 34 to 50%. In addition, concomitant chemoradiotherapy produces better laryngectomy-free survival (organ preservation) than induction chemotherapy in patients with advanced larynx cancer. The use of radiation therapy together with cisplatin has produced markedly improved survival in patients with advanced nasopharyngeal cancer. The success of concomitant chemoradiotherapy in patients with unresectable disease has led to the testing of a similar approach in patients with resected disease as a postoperative therapy, but results to date have not convincingly shown improvement over postoperative radiation therapy alone.