Induction chemotherapy in head and neck cancer

Induction chemotherapy can produce response rates of 60% to 90% which are c omplete in 20% to 50% of previously untreated patients with squamous cell h ead and neck cancer. It was hoped that this dramatic chemotherapy-induced t umor shrinkage would result in more successful locoregional treatment and p rove useful in disease management. Despite many promising phase II studies of neoadjuvant chemotherapy, a large number of well-controlled phase III tr ials have shown no survival benefit. Distant metastases may be reduced, how ever, and organ preservation seems more likely with this method of treatmen t. An understanding of the benefits of chemotherapy in this disease must re cognize the multiple reasons why these patients die, and the need for great er sophistication in our endpoint analysis.