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

Objective: 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. Data sources: A comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases to identify randomized controlled trials (RCTs) comparing NACT with upfront surgery. Review methods: 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 Results: 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 %). Conclusions: 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.