Chemotherapy for head and neck cancer.

This overview of the role of chemotherapy in head and neck cancer is based on clinical trials conducted at The Princess Margaret Hospital and on a critical review of the literature. For recurrent or metastatic squamous cell carcinoma, no drug or combination has been found superior to methotrexate, which in large series gives transient responses in about 25% of patients. Reports of higher rates of response have not correlated with increased survival, and response rates from many series have been inflated by the use of poor and variable criteria of response or by inappropriate exclusion of patients. Chemotherapy may lead to high rates of response when used initially as part of combined modality treatment with radiation and/or surgery, but longterm benefit has not yet been demonstrated. Chemotherapy should not be considered part of standard management for recurrent or metastatic head and neck cancer, and should be used as part of primary treatment for loco-regional disease only in the context of large, well designed clinical trials.