The Role of Chemotherapy in Head and Neck Malignancy

Abstract

SUMMARY Despite 20 years of active investigation, the role of chemotherapy for head and neck malignancies remains largely undefined and continues to be an area for active investigation. Clearly, for patients with recurrent and metastatic disease, palliation can be achieved, with single agent methotrexate being the standard for SCC H & N. Primary chemotherapy still remains largely experimental, except for patients with advanced laryngeal carcinoma. For patients with advanced resectable SCC H & N, new combinations that can achieve greater than 50% complete response rates with acceptable toxicity remain the goal. The concurrent use of chemotherapy and radiation appears promising with survival advantages noted for patients with unresectable SCC H & N. Organ preservation without compromising survival has been noted for advanced laryngeal primaries and is now under active investigation for other sites of disease in the head and neck. The use of intra-arterial chemotherapy may play a role in this regard, particularly for patients with maxillary sinus tumors. The area with the most promise is chemoprevention, with the retinoids showing an impact on reducing second primary aerodigestive tract tumors. New chemopreventive agents and analogues are currently being developed, with combined chemopreventive agent trials forthcoming. Continued emphasis must concurrently be placed on smoking cessation along with these trials.