The Evolution of Induction Chemotherapy in Locally Advanced Squamous Cell Cancer of the Head and Neck: The New Paradigm of Sequential Therapy

Squamous cell carcinoma of the head and neck (HNSCC) represents 5% of newly diagnosed cancers in adult patients seen in the United States. Although HNSCC is a highly curable malignancy when diagnosed at an early stage, many patients present with advanced local-regional disease. Locally advanced disease can be separated into either intermediate (stage III; T3N0M0 or T1-3N1M0) or advanced (stage IV; T4N0-1M0 or T1-4N2-3M0) (1). Stage III patients are generally resectable, and although their prognosis is better a stage IV patients, the prognosis for all these patients, particularly those who are unresectable has remained poor (1–8). The potential for surgical resection, whether surgery is advised or not, defines a better prognosis than the presence of unresectable disease. Thus resectability, site, stage, and performance status are the major prognostic factors for patients with HNSCC. Standard therapy with surgery and/or radiotherapy can be associated with significant morbidity and functional disability, particularly when the tumor arises in the larynx, piriform sinus, or oropharynx (9). In addition, despite aggressive local therapy with surgery or radiotherapy, between 50 and 60% will develop locoregional recurrences, and 20 to 30% will develop distant metastases within 2 yr. Only 20 to 45% will remain disease free and alive at 3 yr.