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Persons who have head or neck cancer that cannot be removed with surgery commonly receive radiation therapy as their primary treatment. However, for many of these individuals, the cancer will still progress at some point. Now, emerging research indicates that the use of chemotherapy combined with radiation therapy for advanced cancer of the head or neck may afford a prolonged survival time for persons who have this disease. Current studies are adding different and potentially more effective drug combinations to the radiation therapy regimen.

The term head and neck cancer is used to refer to a number of cancers that may occur in the head and/or neck. These may include cancers of the tongue, mouth, salivary glands, pharynx, larynx, sinus, and other sites located in the head and neck area. Treatment options may include surgery, radiation therapy, and/or chemotherapy, depending on the specific type, location, and stage (extent of disease at diagnosis) of the cancer. When the cancer has spread throughout the head and/or neck area such that it cannot be removed with surgery (called advanced disease), radiation therapy is often used to control the cancer, relieve the symptoms of disease, and improve survival. Because head or neck cancer can affect vital areas, such as the mouth and throat, maintaining the function of those parts of the body is a significant consideration with this type of disease. Recently, researchers conducted a study to determine whether the combination of radiation therapy and chemotherapy would be more effective than radiation therapy alone in improving treatment outcomes and preserving organ function in persons with advanced head or neck cancer.

Researchers from Chicago treated 76 persons with advanced cancer of the mouth, pharynx, larynx, sinuses, or cervical esophagus. Ninety-three percent of these persons had advanced stage IV disease, but without detectable spread of the cancer to distant parts of the body. Treatment consisted of a combination of chemotherapy with fluorouracil, cisplatin, and hydroxyurea and twice-daily radiation therapy. Thirteen persons were also able to have subsequent surgery to remove cancer at the site where it originally developed, and 39 persons had surgery to remove the lymph nodes in the neck area. After 3 years, 28% of patients had a

recurrence (return) of the cancer, and 55% of patients were alive. Ninety-two percent of the patients had no recurrence at the original site of the cancer, and were able to maintain good organ function.

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These researchers concluded that this aggressive chemotherapy/radiation therapy regimen results in good control of cancer in the head and neck area, organ preservation, and survival rates in persons with advanced cancer of the head or neck. They also noted that, for some persons, surgery may be feasible after receiving this chemotherapy/radiation therapy regimen. Persons who have advanced cancer of the head or neck may wish to talk with their doctor about the risks and benefits of this treatment strategy or of participating in a clinical trial in which other promising new therapies are being studied.

(Journal of Clinical Oncology, Volume 18, No 8, pp 1652-1661, 2000)