THE ROLE OF CHEMOTHERAPY IN HEAD AND NECK-CANCER

We studied the effect of cytoreductive chemotherapy in head and neck c ancer and analyzed it in terms of efficacy, remission rates, and durat ion, as well effect on survival. Single-agent chemotherapy, which form erly was used as a palliative therapy in recurrent and metastatic dise ase, had little affect on survival. More recently, multi-agent chemoth erapy trials have shown significantly higher response rates, but this success has not translated into an added survival benefit. These findi ngs led to the introduction of multi-agent chemotherapy into the induc tion (neoadjuvant) clinical setting. In these clinical circumstances, better objective response rates were found, particularly in the previo usly untreated pat;ent. Although this therapy has resulted in better c ontrol of local disease, the impact on survival is not yet clear. Adju vant chemotherapy is most useful in patients who have a high risk of r elapse. Therapy appears to decrease its incidence. particularly at dis tant sites. Finally, chemoradiation trials have shown that this treatm ent provides a survival advantage. but at the cost of a significant in crease in toxicity.