Stage III and IV Head and Neck Cancer: Does Everyone Need Chemotherapy?

Objectives: Definitive treatment of Stage III and IV squamous cell carcinoma can be with surgical resection, definitive radiation therapy alone or combined radiation therapy with chemotherapy. Radiation and concomitant platinum-based chemotherapy are the accepted gold standard. The purpose of this study was to determine how often patients treated with radiation therapy alone developed locoregionally recurrent disease that in retrospect possibly could have been prevented with the addition of chemotherapy. Methods: 116 consecutive patients with known Stage III and Stage IV head and neck cancers were treated with curative intent with radiation therapy alone. Results of the treatment were retrospectively reviewed. Results: Of the 116 patients treated with radiation alone, 11 (9.48%) died from locally recurrent disease, 6 (5.17%) died from local disease and were never diseasefree, 7 (6.03%) died from metastatic disease, 9 (7.75%) died from disease NOS, 6 (5.17%) died from secondary malignancy, 10 (8.62%) died from ICD (2 oropharynx; 8 larynx), 6 (5.17%) died from uncertain causes, 51 (43.96%) are alive and disease-free, and 10 (8.62%) patients’ final outcome data were not recoverable. Conclusions: Cure rates in selected patients with advanced head and neck cancer may be similar with radiation alone compared to radiation with the addition of chemotherapy.