Is There a New Role for Induction Chemotherapy in the Treatment of Head and Neck Cancer?

The majority of deaths from locally advanced head and neck cancer are due to complications of uncontrolled locore-gional disease, and this pattern of failure must be altered to improve patient survival. Over the past 25 years, thousands of patients with head and neck cancer have been enrolled in clinical trials to test whether the addition of platinum-based chemotherapy to local treatment modalities of surgery and radiotherapy improves overall survival. These studies have taken two approaches. In the first approach, several cycles of neoadjuvant or induction chemotherapy (most commonly cis-platin and infusional 5-fluorouracil) precede definitive locore-gional therapy (i.e., surgery). The second approach is chemo-radiotherapy, the concurrent administration of radiotherapy and chemotherapy. Of the two approaches, only chemoradiotherapy has suc-ceeded in changing outcomes. Numerous phase III trials that have compared radiotherapy alone to chemoradiotherap