Over the past two decades, induction chemotherapy in head and neck cancer has become popular due to the availability of effective agents and to the high objective response rates with combination chemotherapy in untreated and advanced cancer. Single-agent induction chemotherapy with moderate-dose methotrexate (200 mg/m2) did achieve 80% overall response. A combination of cisplatin, bleomycin, and methotrexate also showed 90% overall response in previously untreated patients with stage III and IV disease. Numerous studies support the general observation that initial dramatic response with excellent palliation is seen in patients who have not had any prior regional treatment. Also, chemotherapy responders do better on follow-up than non-responders. However, to achieve the goals of improved relapse-free status and survival, we must recognise the deficiencies of current treatment approaches and explore, in a randomized fashion, new ways to integrate the therapeutic modalities.
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