Current role of chemotherapy in head and neck cancer.

Although cytotoxic chemotherapy is not fully established as an accepted part of the primary management of head and neck cancer, numerous studies over the past 10 years have been undertaken, notably in the USA and Europe. Several classes of antineoplastic chemotherapy have activity and can induce tumour regression in patients with squamous or anaplastic cancers, the most common cell types. While response rates with newer combinations, such as cisplatin and fluorouracil, are reportedly as high as 90%, response duration is generally short-lived. The most promising use of chemotherapy appears to be synchronous or adjuvant therapy with radiotherapy and/or surgery. Combined modality therapy of this type is able to improve the local control rates; 2 prospectively randomised studies from the United Kingdom each with several hundred patients have suggested a possible improvement in overall survival as well. The most active agents are methotrexate, cisplatin, bleomycin and fluorouracil. Further studies are urgently needed to assess the true role of and the indications for chemotherapy, and because of the world-wide importance of these tumours, the identification of even a modest improvement would have profound benefit. The use of chemotherapy outside studies should still be discouraged.