Update on chemoradiotherapy for head and neck cancer.

Locoregionally advanced head and neck cancer is associated with a poor prognosis despite treatment with surgery or radiation or both. In the past several years, chemotherapy has become an integral part of potentially curative therapy for head and neck cancer and has been increasingly used to achieve the goals of organ preservation and prolongation of survival. Since 1998, many randomized studies that compared concurrent chemoradiotherapy with radiotherapy alone have been published. These studies used different chemotherapy regimens, either single-agent or combination, and various radiation fractionation schemes and almost uniformly supported the superiority of chemoradiotherapy over radiotherapy alone in terms of locoregional control as well as overall survival. Given the toxicity of concurrent chemoradiotherapy, careful selection of patients is critical. Many issues remain to be addressed in future trials, including the optimal chemotherapy regimen, the use of altered fractionation radiotherapy, and the role of induction chemotherapy.