It has been known for more than 20 yr that cisplatin-based combination chemotherapy can achieve overall response rates of 70 to 90%, with complete response rates of 20 to 50% in patients with previously untreated locally advanced head and neck cancer (1,2). The use of chemotherapy prior to radiation or surgery is commonly referred to as induction or neoadjuvant chemotherapy. Investigators hypothesized that the addition of an active induction regimen prior to definitive radiotherapy or surgery would have a significant beneficial impact on the outcome of treatment for patients with locally advanced squamous cell carcinoma of the head and neck. As well as the potential to decrease distant metastases, it was hoped that significant tumor shrinkage could contribute to improved local-regional control, and facilitate organ preservation (3). Early single-arm trials confirmed the activity of platinum-based induction regimens and established that sequential induction chemotherapy and radiation was feasible, without any apparent increase in radiation toxicity (4).