Klin Onkol 2005; 18(1): 27-28.
Summary: At the present time concomitant radio-chemotherapy of locally advanced head and neck carcinoma is considered as a standard treatment. This approach is based mainly on the result of Pignon’s meta-analysis MACH-NC collaborative group which suggested 4% benefit in overall survival at 2 years and further 4% benefit in overall survival at 5 years in favour of combined regimens. However, there is no evidence that addition of cytotoxic chemotherapy improves therapeutic ratio and the improvement in survival is based on bias. Most of the randomised trials compare aggressive radiochemotherapy arm with exclusive radiotherapy consisting of 66-70 Gy given conventionally. According to present standards this regime can’t be considered as radical treatment. The main problem is late toxicity of combined regimens which is not sufficiently assessed in most of the trials (51% of long term survivors depending on continuous tube feeding in one trial). The addition of any cytotoxic agent should not compromise the quality of planning process and precision of radiotherapy delivery.
