Treatment

Radiation therapy given together with chemotherapy is a standard of care for patients with locally advanced head and neck cancer. In select situations, such as oral cavity tumors, the patient will undergo surgery followed by radiation therapy and/or chemotherapy.¹ This combination treatment is often used in patients who would develop significant side effects from surgery, in patients with inoperable cancers, and after surgery for certain patients who have a poor prognosis.

In addition, radiation therapists may treat head and neck cancer using external beam treatment or high-dose brachytherapy, a technique in which tiny radioactive seeds are implanted directly in a tumor. In some cases, doctors use both approaches. Memorial Sloan-Kettering radiation oncologists use a three-dimensional method of delivering external beam radiation called intensity-modulated radiation therapy (IMRT) to deliver radiation therapy to tumors with great precision. Using this technique the radiation oncologist can "mold" the dose of radiation to the tumor, making it possible to use higher, more effective doses, while sparing healthy tissues, thereby reducing the side effects. These new approaches can often preserve patients' ability to speak and swallow normally, especially those with advanced disease.

Chemotherapy

Doctors are increasingly using chemotherapy to treat head and neck cancers, especially for patients whose disease would have been considered untreatable not long ago. Chemotherapy can enhance the response of cancer cells to radiation therapy; this combination makes it possible to preserve organs such as the larynx, which surgeons would have removed in the past. For patients with advanced disease, too, chemotherapy is helping to increase longevity; this is especially true for patients who have cancer of the nasopharynx or other areas that are not easily treated surgically. The most commonly used chemotherapy drugs include cisplatin, fluorouracil, methotrexate, carboplatin, paclitaxel, docetaxel, and more recently cetuximab.

Chemotherapy alone is not considered a curative treatment for most head and neck cancers. However, as our understanding of the molecular basis of these tumors grows, physicians are gaining many new targets for drug therapy. The options for patients whose disease will not respond to standard agents are expanding, offering hope to patients with the most difficult tumors.

Find a Clinical Trial Find out about new research studies for head and neck cancers more

Head and neck cancers vary widely in their response to chemotherapy. To spare patients from unnecessary treatment regimens, Memorial Sloan-Kettering researchers are looking at new tools to find out whether a patient's cancer will respond before treatment has begun. One such experimental tool -- the histoculture drug response assay -- might one day permit rapid testing of how a patient's cancer cells respond to commonly used drugs before he or she is treated.

Memorial Sloan-Kettering's clinical research protocols in head and neck cancers -- ranging from new approaches that prevent precancers from becoming malignant to new treatments for advanced and recurrent cancers -- are sometimes offered to eligible patients through the clinical trial process.

¹J. P. Pignon, J. Bourhis, C. Domenge, and L. Designé, Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data, Lancet 355(9208), 2000: 949-55.