Current Treatment Options in Oncology

, Volume 2, Issue 1, pp 7–13

Locally advanced head and neck cancer

  • Merrill S. Kies
  • Charles L. Bennett
  • Everett E. Vokes

Opinion statement

The simultaneous administration of chemotherapy and radiation has produced a significant impact on the treatment of advanced squamous cell carcinomas of the head and neck. Although no single regimen has emerged as the “standard” approach, recent trials have consistently demonstrated the superiority of combined treatment programs over radiotherapy alone for local tumor control and overall survival. More-over, multimodal treatment has emerged with important ancillary goals of organ preservation, improved cosmesis, and enhancement of quality of life. With improving survival in all stages of disease, much attention can be given to identifying effective measures to reduce the risk of metachronous primary cancers in this high-risk group.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Vokes EE, Weichselbaum RR, Lippman SM, et al.: Head and neck cancer. N Engl J Med 1993, 328:184–194.PubMedCrossRefGoogle Scholar
  2. 2.
    Hong WK, Lippman SM, Wolf GT: Recent advances in head and neck cancer-larynx preservation and cancer chemoprevention: the Seventeenth Annual Richard and Hinda Rosenthal Foundation Award Lecture. Cancer Res 1993, 53:5113–5120.PubMedGoogle Scholar
  3. 3.
    Hong WK, Bromer RH, Amato DA, et al.: Patterns of relapse in locally advanced head and neck cancer patients who achieved complete remission after combined modality therapy. Cancer 1985, 56:1242–1245.PubMedCrossRefGoogle Scholar
  4. 4.
    Tupchong L, Scott CB, Blitzer PH, et al.: Randomized study of preoperative versus postoperative radiation therapy in advanced head and neck carcinoma: long-term follow-up of RTOG study 73–03. Int J Radiat Oncol Biol Phys 1991, 20:21–28.PubMedGoogle Scholar
  5. 5.
    Brennan JA, Mao L, Hruban RH, et al.: Molecular assess-ment of histopathological staging in squamous-cell carcinoma of the head and neck. N Engl J Med 1995, 332:429–435.PubMedCrossRefGoogle Scholar
  6. 6.
    The Department of Veterans Affairs Laryngeal Cancer Study Group: Induction chemotherapy plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991, 324:1685–1690.CrossRefGoogle Scholar
  7. 7.
    Lefebvre JL, Chevalier D, Luboinski B, et al.: Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst 1996, 88:890–899.PubMedCrossRefGoogle Scholar
  8. 8.
    Vokes EE: Interactions of chemotherapy and radiation. Semin Oncol 1993, 20:70–79.PubMedGoogle Scholar
  9. 9.
    Lo TC, Wiley Jr AL, Ansfield FJ, et al.: Combined radiation therapy and 5-fluorouracil for advanced squamous cell carcinoma of the oral cavity and oropharynx: a randomized study. Am J Roentgenol 1976, 126:229–235.Google Scholar
  10. 10.
    Shanta V, Krishnamurthi S: Combined bleomycin and radiotherapy in oral cancer. Clin Radiol 1980, 31:617–620.PubMedCrossRefGoogle Scholar
  11. 11.
    Fu KK, Phillips TL, Silverberg IJ, et al.: Combined radiotherapy and chemotherapy with bleomycin and methotrexate for advanced inoperable head and neck cancer: update of a Northern California Oncology Group randomized trial. J Clin Oncol 1987, 5:1410–1418.PubMedGoogle Scholar
  12. 12.
    Gupta NK, Pointon RC, Wilkinson PM: A randomised clinical trial to contrast radiotherapy with radio-therapy and methotrexate given synchronously in head and neck cancer. Clin Radiol 1987, 38:575–581.PubMedCrossRefGoogle Scholar
  13. 13.
    Browman GP, Cripps C, Hodson DI, et al.: Placebo-controlled randomized trial of infusional fluorouracil during standard radiotherapy in locally advanced head and neck cancer. J Clin Oncol 1994, 12:2648–2653.PubMedGoogle Scholar
  14. 14.
    Haffty BG, Son YH, Papac R, et al.: Chemotherapy as an adjunct to radiation in the treatment of squamous cell carcinoma of the head and neck: results of the Yale mitomycin randomized trials. J Clin Oncol 1997, 15:268–276.PubMedGoogle Scholar
  15. 15.
    Bachaud J, Cohen-Jonathan E, Alzieu C, et al.:Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: final report of a randomized trial. Int J Radiat Oncol Biol Phys 1996, 36:999–1004.PubMedCrossRefGoogle Scholar
  16. 16.
    Al-Sarraf M, LeBlanc M, Giri PG, et al.: Chemoradio-therapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Inter-group Study 0099. J Clin Oncol 1998, 16:1310–1317.PubMedGoogle Scholar
  17. 17.
    Vokes EE, Kies M, Haraf DJ, et al.: Induction chemo-therapy followed by concomitant chemoradiotherapy for advanced head and neck cancer: impact on the natural history of the disease. J Clin Oncol 1995, 13:876–883.PubMedGoogle Scholar
  18. 18.
    Kies MS, Haraf DJ, Athanasiadis I, et al.: Induction chemotherapy followed by concurrent chemoradia-tion for advanced head and neck cancer: improved disease control and survival. J Clin Oncol 1998, 16:2715–2721.PubMedGoogle Scholar
  19. 19.
    Vokes E, Kies M, Haraf D, et al.: Concomitant chemo-radiotherapy as primary therapy for locoregionally advanced head and neck cancer. J Clin Oncol 2000, 18:1652–1661.PubMedGoogle Scholar
  20. 20.
    Kies MS: Combined therapy for squamous head and neck cancer [abstract]. Lung Cancer 1999, 25:228–229.Google Scholar
  21. 21.
    Brizel DM, Albers ME, Fisher SR, et al.: Hyperfraction-ated irradiation with or without concurrent chemo-therapy for locally advanced head and neck cancer. N Engl J Med 1998, 338:1798–1804.PubMedCrossRefGoogle Scholar
  22. 22.
    Wendt TG, Grabenbauer GG, Rodel CM, et al.: Simulta-neous radiochemotherapy versus radiotherapy alone in advanced head and neck cancer: a randomized multicenter study. J Clin Oncol 1998, 16:1318–1324. The authors reported a statistically significant 3-year survival advantage after concomitant use of simultaneous radiochemotherapy.PubMedGoogle Scholar
  23. 23.
    Calais G, Alfonsi M, Bardet E, et al.: Randomized trial of radiation therapy versus concomitant chemo-therapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst 1999, 91:2081–2086.PubMedCrossRefGoogle Scholar
  24. 24.
    Jeremic B, Shibamoto Y, Milicic B, et al.: Hyperfraction-ated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: a prospective randomized trial. J Clin Oncol 2000, 18:1458–1464. In this recent report, locoregional control, distant disease control, and overall survival were statistically improved at 5 years.PubMedGoogle Scholar
  25. 25.
    Weinstein MC, Siegel JE, Gold MR, et al.: Recommenda-tions of the panel on cost-effectiveness in health and medicine. JAMA 1996, 276:1253–1258.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Merrill S. Kies
    • 1
  • Charles L. Bennett
    • 2
  • Everett E. Vokes
    • 3
  1. 1.Thoracic/Head and Neck Medical OncologyUniversity of Texas M. D. Anderson Cancer CenterHoustonUSA
  2. 2.Chicago VA Healthcare System/Lakeside DivisionChicagoUSA
  3. 3.University of ChicagoChicagoUSA

Personalised recommendations