The role of concurrent chemotherapy and radiation in the management of patients with squamous cell carcinomas of the head and neck

Abstract

The management of patients diagnosed with squamous cell carcinomas of the head and neck has undergone a major paradigm shift during the past decade. The current application of systemic therapy and radiation has offered this patient population the opportunity for cure while simultaneously achieving organ preservation. Researchers have focused their efforts on optimizing radiotherapy treatment schedules, defining effective chemotherapy combinations, and investigating novel drug delivery procedures. This article will review the results of the early trials that identified the ability of sequential therapy to achieve organ preservation without sacrificing survival. These studies helped pave the way for the development of concurrent chemoradiation strategies. The results of multiple meta-analyses that have served as the basis for recent multi-institutional, randomized trials will be examined. At the same time, investigators have studied the role of altered fractionation radiotherapy schedules in conjunction with both systemic and intra-arterial chemotherapy. Researchers have long appreciated the differences in outcomes of head and neck tumors based on anatomic location. The results of the Intergroup trial that has helped to define the current national standard of care for this patient group will be reviewed. While most studies conducted to date have used platinum and 5-fluorouracil drug combinations, recent trials have begun to investigate the use of taxane-based regimens. The ability to now target cellular protein receptors has led investigators to focus their interest on the potential role for new biologic agents in combined modality treatment schemes. These treatment regimens hold tremendous promise for improving long-term outcomes while maintaining the quality of life for this patient population.