Cisplatin and radiotherapy in the management of locally advanced head and neck cancer

Purpose: This manuscript traces the results of combined modality head and neck cancer trials, with reference to survival and rates of local-regional control and distant metastases, that have led to current Phase III trials testing concomitant cisplatin and radiotherapy. Methods and Materials: The toxicity, local control rates, and survival results of pilot trials and small randomized trials using concomitant cisplatin based chemotherapy and radiotherapy are reviewed. Results: Enhanced mucosal toxicity and myelosuppression occur which affect patient compliance and tolerance of planned chemotherapy, but do not appear to affect delivery of standard fractionation radiotherapy. The encouraging results of single agent cisplatin and radiotherapy trials and those using cisplatin-5-FU and split course radiotherapy have led to the activation of three randomized Head and Neck Intergroup trials. These trials are for Stage III & IV carcinoma of the nasopharynx, Stage III & IV resectable carcinoma of the larynx (organ preservation) and Stage III & IV unresectable carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx. Conclusion: The three Intergroup study designs should allow for a definitive evaluation of concomitant treatment.