Head and neck cancer: a step forward

Abstract

Head and neck cancers have for a long time been orphan cancers for any trials of individualized treatment, at least in part because the number of active cytotoxic drugs has been for a long time rather restricted. Histology did not infl uence treatment modality and the use of particular cytotoxic drugs. Undiff erentiated carcinoma of the nasopharynx was the fi rst tumour type to enhance investigations in individualized treatment, as regards to choice of cytotoxic drugs and combinations of chemo and radiotherapy. Recently the HPV16/18 positive carcinoma of the oropharynx has arisen as a topic for individualized approach. Th e biologicals are relatively late newcomers in the arsenal of drugs available for head and neck cancer. Th e same statement is related to research of possible targets and thus investigations of subpopulations that might benefi t from a particular drug or a particular pathway inhibition. Individualized drug treatment in head and neck cancer appears to be at its promising beginnings. The past decadesIn the last two decades, until recently, few advances have been made in the treatment of head and neck cancer, either in adjuvant, neoadjuvant, concomitant and palliative setting.Since meta-analyses showed a benefi t, concurrent chemoradiotherapy (CRT) widely replaced radiotherapy (RT) alone in the treatment of unresectable head and neck sqamous cell carcinoma (HNSCC) [1][2][3]. Th e principal cytostatic drugs have shown to be 5-fl ourouracil alone, cisplatin alone, mitomycin C alone, or 5-FU and cisplatin [4]. Amongst the platinum derivatives, cisplatin has been proven to be the drug of choice, more active in single drug setting than its analogue carboplatin and therefore the combination of cisplatin and continuously infusional 5-FU emerged as the treatment of choice [5,6]. Th e continuous infusional 5-FU-cisplatin regimen remained the standard, occasional although phase II trials appeared to demonstrate that the 4 h infusional 5-FU was as active as continuous infusional 5-FU when combined to cisplatin in both neoadjuvant and palliative setting [7]. Other cytostatic drugs like capecitabine in combination with paclitaxel or cisplatin are found to be well tolerated and eff ective but still fail to convince as a fi rst-line treatment in unresectable HNSCC [8,9]. Bleomycin and methotrexat in combination with radiation even showed to considerably enhance acute mucosal toxicity without any survival benefi t and therefore have been exluded from a large meta-analysis [1]. In the last decades the unconventional fractionated therapy has been studied extensively and showed that hyperfractionation leads to signifi cant improvement of overall survival, if used as a single modality. On the other hand accelerated radiotherapy alone is not that eff ective, especially in extreme treatments with decreased doses or split course radiation shedule [1,10]. Th e role of altered fractionated radiotherapy in the combined setting with chemotherapy is less conclusive and still under investigation.In adjuvant treatment CRT shoul...