Maxfacts

Chemoradiation (combining chemotherapy with radiotherapy) in head and neck cancer improved the outcome for nasopharyngeal cancer and some poorly differentiated squamous cell carcinoma with the additional benefit of organ preservation.

Recent meta-analysis of studies had shown improved loco-regional control with survival improved by some 8-15% depending on the study (both the EORTC (European Organisation for Research and Treatment of Cancer) and RTOG (Radiation Therapy Oncology Group) groups have produced convincing data). However, the combination of chemotherapy and radiotherapy is associated with increased morbidity and mortality. All the studies failed to contain a surgical control arm and none identified or excluded patients who were non-smokers with HPV driven cancers.

Currently we are seeing the consequences of the widespread application of these hyper-radical treatment regimens, and in some cases quite devastating long term morbidity on the survivors. Its continued use will need appropriate cases and almost certainly will not include those cases which are relatively low risk (HPV driven) or equally treatable using surgery as a single modality.

Chemotherapy by itself has a useful role in palliation in some instances.