Role of Induction Chemotherapy in Locoregionally Advanced Head and Neck Cancers

Standard Treatment Approach

The American College of Oncology recommends concurrent chemoradiation with high-dose cisplatin as the preferred standard treatment for locoregionally advanced disease 1, 2, 3, 4
For resectable stage III-IV tumors, surgery with reconstruction plus postoperative radiotherapy is the primary approach, according to the National Comprehensive Cancer Network 1, 2
When anticipated functional outcomes with surgery are poor in resectable patients, concurrent chemoradiation is preferable to surgery, as suggested by the American College of Oncology 1, 2
For non-resectable patients, concurrent chemoradiation is the definitive standard treatment, recommended by the American College of Oncology 1, 2, 3, 4

The European Society for Medical Oncology states that the only established role for induction chemotherapy is organ preservation in advanced larynx and hypopharynx cancer in patients who would otherwise require total laryngectomy 1, 2, 3, 4, 5, 6
TPF induction followed by radiotherapy in responsive patients allows larynx preservation, according to the American College of Oncology 1, 2, 3, 4
This approach has no negative impact on disease-free or overall survival due to successful salvage surgery, as reported by the National Comprehensive Cancer Network 1, 2, 3, 4, 5, 6

The American College of Oncology notes that TPF demonstrates improved response rates, disease-free survival, and overall survival compared to PF in locoregionally advanced disease 1, 2, 3, 4
Despite improved chemotherapy regimens, most randomized trials from the 1980s-1990s showed no overall survival benefit when induction chemotherapy was added to locoregional treatment, according to the National Comprehensive Cancer Network 8, 9

The American College of Oncology warns that sequential treatment with induction chemotherapy followed by chemoradiation remains under evaluation, with substantial concerns about cumulative toxicity compromising final outcomes 3, 4, 5, 6
No clear advantage in overall survival has been demonstrated from adding induction chemotherapy to concurrent chemoradiation, as reported by the National Comprehensive Cancer Network 9

For T4a disease, the National Comprehensive Cancer Network recommends surgery followed by adjuvant therapy or concurrent chemoradiation as the standard approaches, rather than induction chemotherapy 10
When larynx preservation is the patient's priority and total laryngectomy would otherwise be required, TPF induction followed by radiotherapy in responders is an acceptable option, according to the American College of Oncology 3, 4, 5, 6

The National Comprehensive Cancer Network emphasizes that multidisciplinary consultation is mandatory before initiating any treatment approach 10
Induction chemotherapy may reduce distant metastases but this benefit must be weighed against potential delays in definitive locoregional treatment, as noted by the American College of Oncology 1, 2, 8, 9