Treatment of Locally Advanced Head and Neck Cancer: Historical and Critical Review

Abstract

Background Advanced squamous cell cancers of the head and neck have traditionally been associated with high rates of morbidity and mortality. Advances in management have improved outcomes for most of these patients. Methods The author reviews the historical progress in management of these difficult tumors and adds his own wide experience to describe and evaluate newer approaches to management. Results Over the last 10 years, overall survival rates for patients with head and neck cancers have improved as has quality of life. New standards of care have been defined for patients with nasopharyngeal cancer and for those with advanced unresectable disease. Organ preservation is more commonly achieved. Conclusions Newer targeted therapies are likely to add to the progress that has already been achieved in the multimodality management of patients with head and neck cancers.

Clinical benefits of concurrent capecitabine and cisplatin versus concurrent cisplatin and 5-flurouracil in locally advanced squamous cell head and neck cancer

“…The incidence of mucositis, grade 3 or 4 neutropenia, and grade 3 or 4 febrile neutropenia differed only slightly in the two groups. However, the incidence of hematological toxicity in the current study differed significantly from that in previous studies using 5-FU-based regimens, where the incidence of grade 3 or 4 leukopenia was 29-81% (1,18,22,23).…”

“…Most patients with squamous cell carcinoma of the head and neck present with loco-regionally advanced disease, which is associated with a poor prognosis despite all available treatment (1). Since the treatment has additional effects on functional abilities, such as speech and eating in these patients, recent attempts to improve the major end points of treatment (local control, organ preservation, and overall survival) have focused on the use of concurrent chemoradiation (2)(3)(4)(5)(6)(7).…”

Microvascular free tissue transfer for gene delivery: in vivo evaluation of different routes of plasmid and adenoviral delivery

“…[1][2][3] However, with locally invasive disease, there is a significant chance of leaving microscopic residual disease (MRD) in the surgical bed. 4 The risk of MRD contaminating the surgical field is greatest with large, locally advanced tumours and necessitates resection of large volumes of tissue en bloc to achieve clear margins of excision.…”

Chemoradionuclide Therapy with186Re-Labeled Liposomal Doxorubicin: Toxicity, Dosimetry, and Therapeutic Response

“…1 Following diagnosis of HNSCC, the choice of therapy depends on the site and stage of the cancer and also the overall health of the patient. 2 Surgery and radiation therapy are the primary modalities used to control local cancer (stage I/II) and these patients have a good prognosis. Despite improvements in locoregional treatment by surgery and/or radiotherapy for stages III and IV (70%), the failure rate for either local recurrence or distant metastases is still high.…”