Salvage chemotherapy in recurrent head and neck cancer: The institut gustave roussy experience

Despite the development of innovative approaches (ie, hyperfractionated radiotherapy, and neoadjuvant or adjuvant chemotherapy) the natural history of squamous cell head and neck cancer (SCHNC) has not changed appreciably. The majority of patients are free of distant metastasis at the time of diagnosis but still present with advanced local disease (stage III or IV). Radical surgery followed by radiotherapy is the standard curative approach for patients with resectable disease (5-year survival >80% in early-stage lesions). The remaining patients, who present with locally advanced disease, have a high probability of relapse within 2 years after the initial treatment (which often includes active chemotherapy). Sixty percent to 70% of relapses are locoregional and 20% to 30% show distant metastases. The patients with recurrent SCHNC are generally offered treatment with chemotherapy. The objective response rates reported vary between 15% to SO%, but median survival does not exceed 9 months, This dismal prognosis reinforces the need to consider patient symptoms and quality of life as essential endpoints of treatment. The approach to recurrent SCHNC must be multidisciplinary to identify (1) which patients are still amenable to curative treatment with surgery, external radiotherapy, and/or brachytherapy, alone or in combination, (2) which patients could benefit from aggressive locoregional therapy, and (3) which patients are can