Is there still a role for neoadjuvant chemotherapy in head and neck cancer?

After approximately 20 years of conflicting results from chemotherapy in randomized trials in advanced head and neck cancer, three meta-analyses reviewed its use. All three concluded that chemotherapy was associated with a statistically significant advantage in survival, but that this was low (4% absolute benefit at 2 and 5 years). The improvement in survival was mainly based on the more robust improvement obtained with the concomitant use of chemotherapy and radiotherapy. Induction chemotherapy, in particular, was not associated with any relevant survival advantage. This article reviews current indications for neoadjuvant chemotherapy in advanced head and neck cancer. Implications for current and future research are discussed.