Treatment: Head and Neck Cancer

Three categories of disease are common: localized, locally or regionally advanced, and recurrent or metastatic. Localized disease occurs in about one-third of pts and is treated with curative intent by surgery or radiation therapy. Radiation therapy is preferred for localized larynx cancer to preserve organ function; surgery is used more commonly for oral cavity lesions. Overall 5-year survival is 60-90%, and most recurrences occur within 2 years. Locally advanced disease is the most common presentation (>50%). Combined-modality therapy using induction chemotherapy, then surgery followed by concomitant chemotherapy and radiation therapy, is most effective. The use of three cycles of cisplatin (75 mg/m² IV day 1) and docetaxel (75 mg/m² IV day 1) plus 5-fluorouracil (5-FU) (750 [mg/m²]/d by 96- to 120-h continuous infusion) before or during radiation therapy is more effective than surgery plus radiation therapy, although mucositis is also more severe; 5-year survival is 34-50%. Cetuximab plus radiation therapy may be more effective than radiation therapy alone. Head and neck cancer pts are frequently malnourished and often have intercurrent illness. Those who obtain a remission often develop hypothyroidism. Pts with recurrent or metastatic disease (about 10% of pts) are treated palliatively with cisplatin plus 5FU or paclitaxel (200-250 mg/m² with granulocyte colony-stimulating factor support) or with single-agent chemotherapy (a taxane, methotrexate, cisplatin, or carboplatin). Response rates are usually 30-50% and median survival of about 3 months.