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Head and Neck Cancer pp 213–234Cite as

Organ Preservation-Induction Chemotherapy

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Part of the book series: Cancer Treatment and Research ((CTAR,volume 114))

Conclusion

Induction chemotherapy consisting of high dose cisplatin and infusional 5-FU (PF) followed by definitive radiation therapy for the past decade has been the organ-sparing alternative to surgery for patients with laryngeal and hypopharyngeal squamous cell carcinomas. Recent preliminary data from a large randomized trial, RTOG91-11, comparing this approach with concurrent cisplatin and radiation and radiation alone suggest that induction therapy achieves parity with concurrent therapy with respect to survival, but concurrent therapy seems to offer the possibility of greater rates of larynx preservation. If final results of RTOG 91-11 confirm the preliminary evaluation, it is probable that induction therapy will be displaced by concurrent platinum-based therapy as the standard of care.

In the case of loco regionally advanced disease not amenable to surgical resection and primary sites other than larynx or hypopharynx, the data supporting the routine use of induction chemotherapy prior to definitive radiation are far from definitive. Induction therapy is not part of the standard of care in these situations and should not be routinely used outside of a clinical trial.

The polemics of induction versus concurrent chemotherapy have persisted for more than a decade. However, many promising investigational approaches include incorporation of new agents into a combined approach of both induction chemotherapy and concurrent chemoradiotherapy. With the elucidation of more specific anti cancer targets, one can foresee the development of hybrid treatment plans of drug and radiation delivery that will optimize the anticancer effects of all modalities used.

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  2. Robert H. Lurie Cancer Center of Northwestern University, Feinberg School of Medicine, Chicago, IL

    Brockstein Bruce M.D.  & Masters Gregory M.D.  & 

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Dimitrios Colevas, A. (2004). Organ Preservation-Induction Chemotherapy. In: Bruce, B., Gregory, M. (eds) Head and Neck Cancer. Cancer Treatment and Research, vol 114. Springer, Boston, MA. https://doi.org/10.1007/0-306-48060-3_8

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