Chemotherapy of squamous cell carcinoma of head and neck: the future is now.

In 1996, there is an established role for chemotherapy in head and neck cancer. Patients with recurrent disease will be offered combination chemotherapy. In this setting, investigations of new drugs or combinations and the pursuit of concomitant chemo-reirradiation are of interest. In patients with locoregionally advanced disease, induction chemotherapy can be used with the goal of larynx preservation. In addition, a role for chemotherapy in nasopharyngeal cancer appears to be emerging with increased survival as therapeutic goal. The combination of cisplatin and 5-FU does not need to be tested further, however, a more definitive evaluation of a biochemically modulated PF regimen might be of interest. Furthermore, induction chemotherapy represents an ideal investigational tool in which to further evaluate the activity of several new drugs in head and neck cancer patients. Finally, concomitant chemoradiotherapy has resulted in increased survival in several randomized clinical studies. Given the poor outcome of standard radiotherapy in patients with unresectable disease, we favor the administration of concomitant chemoradiotherapy in this group of patients as a standard therapy. In our opinion, the use of radiation therapy alone in this group of patients should be restricted to patients with poor performance status or other high medical risks that render the administration of chemotherapy unadvisable. Finally, given the high incidence of second malignancies and general medical complications in cured head and neck cancer patients, studies of chemoprevention and good preventive medical care by a medical oncologist should be made available to all patients.