Chapter 30 - Combination of Chemotherapy with Radiation for Head and Neck Cancer

Abstract

This chapter summarizes the rationale and data of different modes of chemotherapy in combination with radiation treatment for the management of advanced head and neck squamous cell carcinoma (HNSCC). The chapter begins with a description of the terminology, definition, and rationale of radiation dose-fractionation schedules. The goals of induction chemotherapy are to reduce the primary tumor, thereby increasing the chance of cure with subsequent local therapy and to eradicate systemic microscopic metastases. In contrast to induction chemotherapy, an increasing body of evidence indicates that concurrent chemoradiation yields a better outcome than radiotherapy alone in patients with advanced HNSCC. In addition, data reveal that the survival benefit of concurrent chemoradiation results from an improvement in locoregional disease control rather than from a decrease in systemic relapse. The primary focus of concurrent chemotherapy is mainly to enhance the cytotoxicity of radiation therapy against macroscopic disease. Adjuvant chemotherapy is used to eradicate microscopic loci presumed to remain after local therapy and to destroy microscopic metastatic deposits. This chapter also reviews the results of representative phase III trials and the outcome of comprehensive metaanalyses.