OPTIMIZATION OF COMBINED MODALITY THERAPY FOR LOCOREGIONALLY ADVANCED HEAD AND NECK CANCER

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Abstract

In recent years, several treatment principles have been firmly established for the treatment of a majority of patients with locoregionally advanced head and neck cancer (HNC). These include (i) therapies are administered with curative intent and (ii) organ preservation is pursued whenever possible. In order to achieve these goals, several tools have emerged as evidence-based approaches. Among these are concomitant chemoradiotherapy, usually with cisplatin as radiation sensitizer, as well as induction chemotherapy with the combination of cisplatin, docetaxel and fluorouracil being best supported by randomized clinical trials. It is unclear which of these approaches might be superior, although concurrent chemoradiotherapy continues to have the most abundant database to support its use.

Current questions are whether or not induction chemotherapy and concomitant chemoradiotherapy should be combined in sequence. A recent randomized trial comparing concomitant chemoradiotherapy versus induction chemotherapy followed by concurrent chemoradiotherapy has been completed and results will be available this spring. There are also questions how to best treat patients with HPV-related HNC. It is possible that less intensive treatment might lead to similar cure rates as the current standard treatment approach. Furthermore, the integration of novel molecular diagnostics and therapeutic agents is under investigation.

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