Controlled trials of synchronous chemotherapy with radiotherapy in head and neck cancer: overview of radiation morbidity.

Recently published overviews of randomized controlled trials of simultaneous chemotherapy with radiotherapy in squamous cell carcinoma of the head and neck have demonstrated a significant survival advantage from the combined treatment compared with radiotherapy alone. However, they also showed that chemotherapy increased acute radiation morbidity, but there was no information on late effects. The 19 publications of trials of simultaneous chemotherapy contained in the overview by Munro were reviewed for morbidity data. It was found that chemotherapy significantly enhanced both acute and late effects, suggesting that the drugs may be merely dose-modifying. Future trials should be designed to determine whether or not chemotherapy improves the therapeutic ratio.