It was not too many years ago that the role of chemotherapy for head and
neck cancer consisted of single-agent methotrexate for selected patients
with recurrent disease. In the past decade, multiple new agents,
high-dose chemotherapy, combinations, and intra-arterial approaches have
been used for the patient with recurrent disease. Wheeler critically
assesses the current status of these approaches. When oncologists began
testing chemotherapy in the combined modality approach, trials consisted
of induction chemotherapy and use of single agents as radiosensitizers.
Although a great deal has been learned from these trials, benefit in
terms of survival has been marginal. Even more promising may be the
concomitant use of combination chemo- therapy and radiation. Taylor
describes the encouraging results as well as the potential. Induction
chemotherapy may have a second important goal in addition to improving
curability-it could be used for organ preservation. Dimery et al.,
present the background for this approach in the patient with laryngeal
cancer as well as a description of their randomized trial for voice
preservation. Head and neck squamous cancers are a heterogeneous group
of diseases, and surgeons have long sought parameters that will help
predict outcome.