Update in head and neck oncology

Article Outline

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Since the last issue of Seminars in Oncology fully devoted to head and neck cancer, a great deal of progress has been made. Scientific discoveries have been made in the characterization of molecular events in head and neck carcinogenesis and chemoprevention, in therapy, and in rehabilitation.

In this issue of Seminars, leading investigators in their respective fields describe these recent findings. The issue begins with a review of the molecular biology of head and neck cancer. Considerable information has been gathered over the last decade, giving us a more thorough understanding of early events and molecular alterations, many of which can be therapeutically exploited. For example, recent research has evaluated potentially important biologic roles for the epidermal growth factor receptor, human papiloma virus antigens, and tumor angiogenesis in head and neck cancer. In addition, a decade ago, there was considerable promise for clinically applicable chemopreventive strategies. Unfortunately, such strategies to date have failed to translate into clinical reality. Strategies based on administration of retinoids to high-risk populations have been shown to be of limited effectiveness in the prevention of second malignancies in the head and neck. Newer strategies and additional agents are currently under investigation.

Therapeutically, much progress has been made. Larynx preservation is now an accepted therapeutic approach for the majority of patients with laryngeal cancers. Similarly, for those with unresectable disease, concomitant chemoradiotherapy is a frequently curative therapeutic approach that now has been confirmed to be superior to single-modality radiotherapy. In the postoperative setting, promising data supporting concomitant chemoradiotherapy also have been generated. As reviewed, the optimal approach for combined modality therapy, ie, sequential, concomitant, or both, and the integration of newer chemotherapy and molecularly targeted agents into these treatment settings are of current high interest.

Progress has been more limited for patients with recurrent or metastatic disease treated with single-modality chemotherapy. While novel promising agents clearly have been identified in this setting, focused continued research and speedy evaluation of new promising agents is required. Finally, as an increasing number of patients are treated with curative intent and a higher proportion of them survive their disease, long-term evaluation of disease and treatment sequelae such as swallowing function and speech are necessary. Simple and more reliable tools to evaluate these functions will need to be incorporated into prospective clinical trials.

It is our hope that the summary provided in this edition of Seminars in Oncology will serve as a useful overview of the current state of art and promises for the future.