Multidisciplinary approach for the treatment of head and neck cancer

Abstract

Head and neck cancer is the fifth most frequent cancer in the world, affecting about 500,000 patients annually [1]. According to the cancer statistics in Japan, the number of deaths due to head and neck cancer (oral, pharyngeal, and laryngeal) in 2007 was 7,478, accounting for 2.2 % of all cancer deaths. The number of patients with head and neck cancer (oral, pharyngeal, and laryngeal) in 2003 was 15,384, and the number is increasing annually [2]. According to the National Head and Neck Malignant Tumor Registry (fiscal 2003), the incidences by sites of primary lesion were the oral cavity, 59.1 %; the larynx, 15.7 %; hypopharynx, 9.6 %; oropharynx, 8.4 %; nose and paranasal sinuses, 5.1 %: and nasopharynx, 2.2 %. The main methods of treatment for head and neck cancer are surgery and radiotherapy. However, because more than 60 % of patients at first presentation to the hospital with this disease are in advanced stages (stages III and IV), multidisciplinary treatment including drug therapy, primarily chemotherapy, is performed in clinical practice to improve the treatment results. The goal of treatment of head and neck cancer is primarily prolongation of survival time similar to other cancers. However, because head and neck cancer occurs at sites where functions essential for daily living, such as respiration, swallowing, and vocalization, are centered, quality of life often becomes the priority of the treatment. Multidisciplinary approach therapy becomes very important because of the significance of organ function maintenance and morphological preservation. The modality which has markedly developed in the past 30 years is drug therapy. Cisplatin (CDDP) is the key drug and is used singly as a standard for chemoradiotherapy worldwide. Treatment with CDDP and 5-FU has become the multidrug therapy most commonly used since the report by Kish et al. [3]. For the treatment of advanced head and neck cancer, chemoradiotherapy (CRT) combined with radiotherapy at the same time has become a standard treatment. Many randomized controlled trials of CRT are being carried out in Europe and America. It has been proved that the 5-year survival rate is improved by adding chemotherapy to radiotherapy in meta-analyses of 63 randomized controlled trials carried out between 1965 and 1993, and our results showing the biggest improvement in survival by adding radiotherapy to chemotherapy [4, 5] has been confirmed. Furthermore, combination treatments with various chemotherapeutic drugs are being examined in the subsequent randomized, controlled, phase III study. Most of these controlled trials are of unresectable cases, and most report predominantly chemotherapy combinations rather than radiotherapy alone. Although induction chemotherapy and CRT with multidrug therapy are effective, it may be difficult to use because it is highly toxic. Also, the improvement in survival found with CRT as compared with radiotherapy alone was not found in those advanced cancer patients who were 70 years or older in the recent metaanalysis. However, in recent years, various molecular targeted drugs have been developed and epoch-making results have been reported for breast cancer, colorectal cancer, malignant lymphoma, and chronic myelogenous leukemia. Clinical trials of many molecular targeted drugs for head and neck cancer are already advanced in Europe and America. As a result, combination treatments with M. Fujii (&) National Hospital Organization Tokyo Medical Center, Tokyo, Japan e-mail: fujiimasato@kankakuki.go.jp