Neoadjuvant chemotherapy preceding definitive surgical treatment for head and neck squamous cell carcinoma: A systematic review and meta-analysis

This study evaluates the impact of platinum-based neoadjuvant chemotherapy (NACT) on response rates (RR), overall survival (OS), disease-free survival (DFS), and adverse events (AE) in head and neck squamous cell carcinoma (HNSCC) to inform treatment strategies. A comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases to identify randomized controlled trials (RCTs) comparing NACT with upfront surgery. Search terms including variations of ‘head and neck squamous cell carcinoma’, ‘neoadjuvant therapy’, and ‘randomized controlled trial’ were used. Eligible RCTs were analyzed using a random-effects model Out of 6104 screened studies, 12 studies describing nine unique RCTs (n = 1601) were included. The pooled RR with NACT was 63 % (95 % CI: 46–78 %). Meta-analysis showed no significant differences in OS (HR 0.95, 95 % CI 0.82–1.11) or DFS (HR 0.87, 95 % CI 0.70–1.08) between the NACT and upfront surgery groups. However, NACT regimens comprised of a platinum and fluorouracil with or without a taxane (TPF/PF) showed a significant improvement in DFS (HR 0.76, 95 % CI 0.61–0.94) but not in OS (HR 0.86, 95 % CI 0.70–1.06). The estimated rate of grade 3–5 AEs following NACT was 31 % (95 % CI: 21–43 %). NACT did not significantly improve OS or DFS among all studies. However, TPF/PF regimens showed a significant DFS benefit, suggesting a potential advantage in using regimens for patients with HNSCC.