Neoadjuvant Chemotherapy in Head and Neck Cancer Revisited

Neoadjuvant chemotherapty (NACT) in the early days was employed to increase the locoregional control rate, to reduce the occurrence of distant metastases, and finally to improve the disease-free survival and overall survival.

Unfortunately, the outcome of most randomised trials have been disappointing in all these apects apart from a favourable influence on the developments of distant metastases. However, this effect evidently was not big enough to translate into an improved survival.Indeed, based on these randomised trials and the outcome of the individual patient-based meta-analysis more attention has been given lately to the concurrent use of chemotherapy and radiation therapy (chemoradiation). This is true both for patients with resectable and nonresectable disease.Several research groups have questioned whether leaving out NACT in the treatment program is the right way to go, because by doing so there is a change in the pattern of recurrences, with recipients now failing from distant rather than local disease.Moreover, the negative attitude towards NACT is now changing since the outcome of two larger randomised trials have shown that with the introduction of newer cytotoxic agents in the NACT regimens, significant survival benefit indeed can be obtained.Most impressive in that sense are the data with the TPF regimen (docetaxel plus cisplatin and 5-FU)in patients with unresectable locally advanced disease, a group of patients who notoriusly is doing very poorly. For these reasons NACT in head and neck cancer should be revisited. NACT and chemoradiation seem to have complementary effects on overall disease control, with the former leading to a reduction of distant metastases and the latter enhancing locoregional control. Combining both seems the new way to go.(Source: MOGA/FRO Conference Abstracts: August 2004)