Adiuvant Chemotherapy in Head and Ne'ck Cancer

Adjuvant chemotherapy may be used in three ways in the treatment of squamous cell carcinoma of the head and neck: as induction therapy before other forms of treatment; concomitantly with radiotherapy; or as maintenance therapy after radical radiotherapy and/or surgery. Induction therapy is now termed neoadjuvant if the patient is “chemotherapy-naive,” ie, he or she has not received prior chemotherapy. This article reviews all the trials of adjuvant chemotherapy in squamous carcinoma of the head and neck that are published in the English language. Several trials were excluded from the analysis for the following reasons: first, several well-designed studies do not report the survival rates’m5; second, one study was not correctly randomized, as the control arm consisted of those rejected for radical treatmen@; third, one trial did not include an arm receiving conventional treatment only7; and, fourth, one trials relied on historical controls. The remaining were 28 randomized controlled trials with survival data.g”7 For trials that have been reported on several occasions, the data from the latest report have been used. One trial has been reported in two parts. i5,** The data for dosage, timing of chemotherapy, site, stage, and local treatment of the tumor are shown in Tables 1 through 3. These trials are analyzed from the following several aspects: design of the trial, response rates, survival, site of failure, and toxicity.