Locally advanced squamous cell carcinoma of the head and neck: Approaches combining chemotherapy and radiation therapy
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- Everett E Vokes, MD
Everett E Vokes, MD
- John E. Ultmann Professor
- Chairman, Department of Medicine
- Physician-in-Chief, University of Chicago Medicine and Biologic Sciences
- Avraham Eisbruch, MD
Avraham Eisbruch, MD
- Professor and Associate Chair for Clinical Research
- Department of Radiation Oncology
- University of Michigan
- Section Editors
- Marshall R Posner, MD
Marshall R Posner, MD
- Section Editor — Cancer of the Head and Neck
- Professor of Gene and Cell Medicine
- The Tisch Cancer Institute
- Icahn School of Medicine at Mount Sinai
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
Definitive local therapy (surgery and/or radiation therapy [RT]) is the key component of the initial treatment of locally advanced squamous cell head and neck cancer but is associated with high rates of locoregional and distant recurrence. In addition, treatment can cause considerable morbidity, including loss of swallowing and larynx function.
In an effort to improve cure rates and functional outcomes, chemotherapy has been integrated into various multimodality approaches. These approaches have been applied for both patients with unresectable cancers and those with resectable disease who prefer a non-surgical organ preservation technique.
Combined modality functional organ preservation approaches that have been studied in patients with locoregionally advanced head and neck cancer in addition to definitive RT alone include:
●Induction (neoadjuvant) chemotherapy (chemotherapy prior to surgery and/or RT)
●Concurrent chemoradiotherapy, in which chemotherapy is administered at the same time as RT. This approach has included variant schedules in which cycles of induction chemotherapy are alternated with RT . Newer targeted therapies can also be combined with concurrent radiation.
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- SELECTION OF AN ORGAN-SPARING TREATMENT APPROACH
- Definitive locoregional therapy alone vs chemotherapy plus definitive locoregional therapy
- Induction plus concurrent chemotherapy versus concurrent chemotherapy alone
- Patient selection
- CHEMOTHERAPY REGIMEN
- Induction chemotherapy
- Concurrent chemotherapy
- - Cisplatin
- - Carboplatin
- - Epidermal growth factor inhibition
- Cetuximab alone plus RT
- Cetuximab plus cisplatin plus RT
- Panitumumab plus cisplatin
- Erlotinib plus cisplatin
- RADIATION THERAPY PLANNING
- Initial assessment
- RT treatment plan
- RT schedule
- Duration of treatment
- - Interval between induction chemotherapy and RT
- - RT delivery time
- ROLE OF SURGERY
- Primary tumor
- Management of the neck
- COMPLICATIONS AND SUPPORTIVE CARE
- Prevention of infection
- - Granulocyte colony-stimulating factor
- - Prophylactic antibiotics
- - Summary
- POSTTREATMENT SURVEILLANCE
- SUMMARY AND RECOMMENDATIONS