جايگاه شيمي درماني اوليه در سرطانهاي غيرمتاستاتيك سر و گردن

Place of Primary Chemotherapy in Nonmetastatic Head and Neck Epidrmoid Carcinoma

Primary chemotherapy as a curative treatment always has been considered in nonmetastatic head and neck carcinoma with the purposes of improving loco regional control, decreasing probability of distant metastasis and improving overall survival . Although its improving effect on loco regional control and increasing probability of organ preservation, especially in laryngeal carcinoma has been shown and there are many reports which suggest at least delaying distant metastasis with primary chemotherapy however randomized controlled trials have not yet reported significant improvement of overall survival. Though many of these studies have some essential structural faults, a curative chemotherapy on its own has a relative effect that means with every chemotherapy course one log of tumor cells dies and in spite of several courses it never sterile the tumor. In addition available chemotherapy drugs, single or in combination are not the most effective ones and studies to find more effective drugs continue. On the other hand. loco regional recurrence-synchronous or earlier than metastasis-that is very common with low potency loco regional treatments in locally advanced head and neck carcinomas compromise the limiting effect of chemotherapy on overall survival. While enthusiasm on neoadjuvant and concurrent chemotherapy is raising nowadays, and both involve in organ preservation treatments only the latter has a relative effect on survival improvement. Therefore concurrent chemo radiotherapy with insistence on keeping dose intensity of both modalities while increasing acute but not delayed normal tissue toxicities is the promising measure for operable or inoperable stage III and nonmetastatic stagelV head and neck carcinomas.