Organ Preservation in Head and Neck Cancer

Organ-function preservation is applied to those situations in which the alternative treatment strategy is a surgery that results in substantial impairment of speech or swallowing function. Organ preservation, or more precisely, organ function conservation, can be achieved by combining chemotherapy and radiotherapy and reserving surgery to manage the neck, when indicated. The two nonsurgical strategies that have been tested extensively are induction chemotherapy followed by radiotherapy in responding patients and concurrent radiotherapy and chemotherapy. A combination of chemotherapy with a platinum agent and 5-fluorouracil has been utilized in the majority of clinical trials demonstrating benefits in local control and survival. However, this combination of chemotherapy is frequently associated with significant local-regional toxicity as well as hematologic toxicity. Concomitant, single-agent, low-dose daily cisplatin is an alternative to combination chemotherapy, as this regimen has demonstrated improved local control, progression-free survival, distant metastasis-free survival, and overall survival in two well-controlled trials when administered with conventional fractionation or hyperfractionated radiotherapy.