Fortschritte in der Therapie von Kopf- und Halstumoren. 2. Teil: Radiochemotherapie.

PURPOSE: Local recurrences are one of the main reasons of failure of therapy for locally advanced cancer of the head and neck. Concomitant chemoradiotherapy and accelerated radiation techniques are supposed to improve the locoregional control rates. METHODS: We review the theoretical background and the most important larger clinical trials using concomitant or alternating chemoradiotherapy. The data of alternative fractionation schedules are also briefly reviewed. RESULTS: For many chemotherapy agents a radiosensitizing effect has been shown. Significantly improved locoregional control has been shown for mitomycin C, cisplatin and 5-fluorouracil. Most studies failed to show improved survival. The major factor for this negative result is the common multimorbidity of patients leading to death of other causes then cancer. CONCLUSION: Concomitant, alternating or split course chemoradiotherapy can improve locoregional control. Improved survival has been shown rarely. Confirmatory studies are necessary before adapting this approach in daily practice outside clinical trials. Accelerated hyperfractionation with or without chemotherapy may further improve the control rates. Reirradiation with concomitant chemotherapy in recurrent tumors achieves complete response rates of over 40%.