Adjuvant treatment of locally-advanced head and neck tumours.

Every year about 40,000 new patients are diagnosed as having squamous cell carcinoma of the head and neck (HNSCC) and nearly 60% of this population present with locally-advanced, but non-metastatic, disease. For many years, radiation therapy (RT) alone has been the standard non-surgical treatment for locally-advanced disease. Nevertheless, even the most effective RT regimens (the once-daily, hyperfractionation, or accelerated fractionation) show an improvement in local control rates of 50%-70% and disease-free survival rates of 30%-40%. These modest results have stimulated the search for novel strategies combining RT and chemotherapy. Several chemotherapeutic agents have been tested in combination with RT and cisplatin appears to be the most powerful agent in the treatment of locally-advanced head and neck tumours; as has been demonstrated in a large meta-analysis and, recently, in two multi-centred randomised trials. Based on these results, concurrent chemo-radiotherapy may be considered the standard adjuvant treatment for locally-advanced head and neck tumours.