Evaluation of new treatment methods for head and neck cancer: a challenge.

Surgery and radiotherapy are still the best local and regional treatments for the majority of head and neck cancer patients, each alone having an impressive cure rate. However, it appears that surgery and radiotherapy have reached their upper limits. To improve the results obtained by surgery and radiotherapy, combined approaches with chemotherapy or immunotherapy must be further explored. Prospective randomized trials are essential for the evaluation of the efficacy of such multimodality treatments. Although there is an increasing commitment to this type of clinical research amongst otolaryngologists/head and neck surgeons, we still lag considerably behind other surgical and medical disciplines. Broad peer support is the conditio sine qua non that prospective randomized studies will be successfully conducted in head and neck oncology. Such studies, irrespective of their outcome in terms of which treatment is best, will provide data on important issues like that of failure sites. Accurate evaluation of the magnitude of the failure problem at respectively the local, the regional and the distant level are essential for estimating the potential for gains and establishing priorities for clinical research.