Chemotherapy advances in head and neck oncology.

Chemotherapy has an expanding role in the treatment of squamous cell carcinoma of the head and neck. Patients with recurrent or metastatic disease that have a good performance status should receive combination therapy with cisplatin and 5-fluorouracil or enter investigational protocols. Neoadjuvant chemotherapy should be offered to patients with laryngeal carcinoma as an alternative to surgery. Adjuvant chemotherapy should be considered in patients with an increased risk for relapse. Combined chemoradiotherapy may improve locoregional control and impact on survival. Chemoradiotherapy warrents further investigation through clinical trials and should be considered for patients at high risk for relapse. As the biology of these tumors becomes better defined, so too will our ability to define subsets of patients who may benefit from combined modality treatment.