[Head and neck cancer].

The purpose of this paper is to discuss the recent advances of cancer chemotherapy for head and neck cancer from the viewpoint of survival, focusing on 1) neo-adjuvant chemotherapy, 2) concurrent radiotherapy and chemotherapy, 3) adjuvant chemotherapy, and 4) chemotherapy for palliation. Although neo-adjuvant chemotherapy did not increase survival, it produced a higher rate of organ preservation in some sites such as the larynx and maxilla. Concurrent radiotherapy and chemotherapy form the most promising primary chemotherapy approach to prolong survival of patients with locally advanced resectable and unresectable disease. It is the only systemic approach consistently shown to improve local-regional control and survival in randomized trials. The lack of impact on distant relapse rates, however, suggests that concurrent chemotherapy and radiotherapy should be followed by adjuvant chemotherapy. No survival benefit is evident in adjuvant chemotherapy trials, but some randomized trials including ours produced a significant reduction in the distant relapse rate. As for chemotherapy for palliation, the 5- and 10-year survival were 3.8% and 2.5%, respectively, in patients with local-regional diseases who received chemotherapy for palliation, according to our results. In the patients with distant relapse, the median survival was 10 months, ranging from 2 to 53 months.