Induction and adjuvant chemotherapy for head and neck cancer: future perspectives.

Induction and adjuvant chemotherapy have been studied in combined modality trials over the last two decades. Induction chemotherapy as a strategy has failed to improve survival or local-regional control although some studies have reported a decrease in the rate of development of distant metastases. The role of induction chemotherapy is limited to preserving the larynx for patients with larynx or hypopharynx primaries. Trials of adjuvant chemotherapy or chemoradiation in resected patients suggest benefit for those with high risk features (multiple involved nodes, extracapsular extension, positive surgical margin). Definitive randomized studies are in progress in the United States and Europe. New targeted therapies will be investigated in future trials to improve survival.