About 30,000 new cases of thyroid cancer are diagnosed annually in the United States. The incidence among men has risen more dramatically than any other malignancy in recent years (2.4% annual increase). Thyroid cancers arise from one of two cell types, namely follicular and parafollicular cells.
Arlene A. Forastiere, MD
Based on positive results from the Radiation Therapy Oncology Group (RTOG) 85-01 trial, the conventional nonsurgical treatment of esophageal carcinoma is combined-modality therapy. Dose intensification of the RTOG 85-01 regimen, examined in the Intergroup (INT)-0123/RTOG 94-05 trial, did not improve local control or survival. Areas of clinical investigation include the development of combined-modality therapy regimens with newer systemic agents, the use of 18F-fluorodeoxyglucose positron-emission tomography to assist in the development of innovative radiation treatment planning techniques, and the identification of prognostic molecular markers. The addition of surgery following primary combined-modality therapy apparently does not improve survival, but this finding is controversial.
Argiris and colleagues present
a comprehensive review of
25 years of phase II/III trials
using multimodality therapy for locally
advanced head and neck squamous
cell cancer (HNSCC). They
focus on two approaches: induction
chemotherapy followed by definitive
local therapy (surgery and/or radiotherapy)
and concurrent chemoradiotherapy.
In sorting through these
trials, the authors review the controversies
in the management of locally
advanced HNSCC, while also presenting
a rationale for a unified approach-
combining induction and
concomitant chemoradiotherapy in a
multimodality treatment paradigm.
Evidence from several recent studies
suggests that this strategy will benefit
a subset of patients with locally advanced
disease. The stage is set for
the reevaluation of the benefit of induction
chemotherapy prior to definitive
chemoradiation. To that end, three
different prospective phase III trials
are under way in the United States.