Chemotherapy for localized head and neck squamous cell cancers
Concomitant chemotherapy with cisplatin (100 mg/m2 every 3 weeks) improves outcome for high-risk patients in the postoperative setting and for inoperable disease. Toxicity is increased. Other schemes of potentiation are sometimes used to reduce toxicity, but efficiency is diminished. Cetuximab also improves outcome, but there has been no direct comparison with cisplatin. Immunotherapy is currently being evaluated in association with radiation therapy. Trials are ongoing to evaluate the impact of de-escalation for human papillomavirus-positive patients. The association of docetaxel, cisplatin, and 5-fluorouracil is the standard of induction; it is also the standard treatment for laryngeal preservation. Many trials have attempted to compare the concomitant approach with the sequential treatment; none have managed to show a difference between the two. After induction chemotherapy, there is still no standard of potentiation of radiotherapy.