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Head and Neck Cancers

Multidisciplinary Management of Locally Advanced SCCHN: Optimizing Treatment Outcomes

Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

Key Words. Cetuximab • Radiotherapy • EGFR • SCCHN • Head and neck cancer

Correspondence: K. Kian Ang, M.D., Ph.D., Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 0097, Houston, Texas 77030, USA. Telephone: 713-563-2323; Fax: 713-563-2331; e-mail: kianang{at}mdanderson.org

Received September 4, 2007; accepted for publication June 27, 2008; first published online in THE ONCOLOGIST Express on August 13, 2008.

Disclosure: K. K. A. has acted in a consultant/advisory role for Bristol-Myers Squibb, ImClone, Sanofi-Aventis, and AstraZeneca, and has received research funding from Amgen and ImClone. The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers.

The management of locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) is highly complex. Data from recent clinical trials have altered the treatment landscape by refining the use of existing therapies, such as radiation therapy and chemotherapy, and providing new treatment options, such as cetuximab. Selecting the most appropriate treatment for an individual patient requires a multidisciplinary approach and careful assessment of the relative advantages and disadvantages of each treatment approach. Surgery is highly effective but can have debilitating long-term consequences. Chemoradiation and altered fractionation radiation therapy are more effective than conventional radiation therapy, but also more toxic; as a consequence of toxicity, suboptimal delivery of radiation may diminish, in practice, the efficacy observed in clinical trials of these strategies. Cetuximab plus radiation therapy is more effective than radiation alone and does not substantially increase radiation-related toxicity, or affect the delivery of planned radiotherapy. However, whether cetuximab plus radiation therapy is similar in efficacy to chemoradiation is unknown at this time. Ideally, multidisciplinary teams weigh all these factors when making individual treatment decisions. Data from current trials will help further optimize multimodality treatment for LA-SCCHN.