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The chemoradiation paradigm in head and neck cancer

Nature Clinical Practice Oncology volume 4, pages 156–171 (2007)Cite this article

Abstract

In this article, we use the example of head and neck cancer to show how concurrent chemoradiotherapy is used to treat a cancer where locoregional control is central for treatment success. The advent of concurrent chemoradiation has significantly contributed to the curability of head and neck cancer, including locoregionally advanced disease. Preserving organ function and reducing toxic effects are increasingly the focus of clinical trials. We review the available chemoradiotherapy platforms used for head and neck cancer, with initial discussions focused on single-agent cytotoxic-based regimens. We then assess the literature on multiagent-based regimens and include a discussion of the integration of novel agents, such as EGFR inhibitors, and antiangiogenic drugs into treatment platforms. Although single-agent cisplatin-based chemoradiotherapy is still widely used as a standard therapy, we propose that evidence increasingly shows that multiagent-based chemoradiotherapy, and EGFR-inhibitor-based treatments, offer distinct advantages. We provide guidance for clinicians based on current clinical trial evidence on how to choose appropriate treatment platforms for their patients.

Key Points

  • Head and neck cancer, including advanced stages without distant disease, is curable in more than 50% of cases

  • Locoregional control is imperative for successful head and neck cancer treatment; locoregional recurrence remains the dominant cause of treatment failure and only intensive multiagent chemoradiotherapy platforms have been able to reverse this failure pattern (distal > locoregional)

  • Concurrent chemoradiotherapy is more efficacious than radiation alone or sequential chemotherapy and radiation, and can be used as a primary treatment or in the adjuvant setting

  • Cisplatin chemotherapy given concurrently with radiotherapy is the best studied platform, but cisplatin-related toxicities and evidence of higher survival have lead to the increasing adoption of multiagent-based chemoradiotherapy platforms

  • Anti-EGFR based chemoradiotherapy is efficacious and well tolerated, but no comparative data with standard chemoradiotherapy exists, and we recommend its use only for elderly patients and patients with poor performance status until additional data becomes available

  • There is limited evidence supporting the use of hyperfractionation, accelerated fractionation with concomitant boost, and intensity-modulated radiation therapy in order to further improve treatment outcomes in head and neck cancer patients

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Figure 1: Evidence-based treatment algorithm for management of locally advanced head and neck squamous cell carcinomas
Figure 2: Schematic overview of various treatment approaches for adjuvant or definitive treatment

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  1. TY Seiwert is a Fellow in the Department of Medicine, JK Salama is an Instructor in the Department of Radiation and Cellular Oncology and EE Vokes is the John E Ultmann Professor of Medicine, Radiation and Cellular Oncology and Director of the Section of Hematology/Oncology in the Department of Medicine at the University of Chicago, Chicago, IL, USA.,

    Tanguy Y Seiwert, Joseph K Salama & Everett E Vokes

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Correspondence to Tanguy Y Seiwert.

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EE Vokes has been a consultant for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Genentech, ImClone, OSI and Sanofi-Aventis. The other authors declared they have no competing interests.

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Seiwert, T., Salama, J. & Vokes, E. The chemoradiation paradigm in head and neck cancer. Nat Rev Clin Oncol 4, 156–171 (2007). https://doi.org/10.1038/ncponc0750

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