Radical surgery followed by postoperative
radiotherapy is still the most effective treatment option for advanced resectable
head and neck cancer. It is therefore of utmost importance to determine the resectability before start of the treatment. For those patients who suffer from unresectable
cancer or refuse to undergo surgery, alternatives, such as
induction-chemotherapy or
radiotherapy plus
chemotherapy alone may be offered. Historical studies investigating alternative treatment protocols were conducted almost 20 years ago. These studies demonstrated that in approximately 2/3 of all patients with laryngeal and
hypopharyngeal cancer undergoing
induction-chemotherapy according to the PF-protocol (
cisplatin plus 5-FU as a continuous infusion) and subsequent
radiotherapy, larynx preservation without negative impact on overall survival could be achieved. At least three randomized studies have shown a clinical advantage for a treatment combination consisting of
docetaxel or
paclitaxel plus CDDP/5-FU over a historical control regimen containing CDDP/5-FU alone. This novel combination therefore is currently regarded as the gold-standard for
induction-chemotherapy in advanced
head and neck cancer patients. A further significant addition to the therapeutic armamentarium for the head and neck radiation oncologist is the recently introduced
monoclonal antibody cetuximab. It was found in a randomized landmark study that addition of
cetuximab to
radiotherapy significantly improves local control as well as overall survival of advanced stage
head and neck cancer patients. In light of these recent developments this review discusses the role of
organ sparing treatment protocols and different levels of evidence with special consideration of
tumor localization.