Radiosensitization of advanced squamous cell carcinoma of the head and neck with cisplatin during concomitant radiation therapy

Treatment regimens for advanced squamous cell carcinoma of the head and nec k require both attention to local tumor burden as well as contingencies for control of disseminated disease. Relatively new protocols utilizing cispla tin for radiosensitization of tumor cells during concomitant radiotherapy h ave shown progress in providing effective tumor control. Cisplatin as a che motherapeutic agent induces DNA changes in malignant cells that may be muta genic or lethal. Additionally, when used concurrently with radiation therap y, cisplatin acts as a radiosensitizer, increasing damage to malignant nucl ear DNA to enhance the anti-neoplastic capability of radiotherapy. The mech anisms by which this radiosensitization occurs remain controversial, althou gh one leading theory involves cisplatin's ability to inhibit sublethal dam age repair in radiated tumor cells. Recent investigations utilizing cisplat in with concurrent radiation for treatment of advanced squamous cell carcin omas of the head and neck are reviewed. The variations in protocols present ed include route of administration, dosing, scheduling, timing with surgery , and combination therapy with 5-fluorouracil and radiation. Higher respons e rates, prolonged mean survival, increased survival rates, longer local re currence-free survival rates, and considerable organ preservation with the use of concurrent cisplatin and radiation have been demonstrated by these s tudies. Further investigation of concurrent cisplatin and radiotherapy in p atients with advanced disease is justified.