Neoadjuvant Chemotherapy With Paclitaxel, Carboplatin, and Cetuximab for Locally Advanced Head and Neck Cancer

In locally advanced head and neck squamous cell carcinoma (HNSCC), rapid tumor progression during the preoperative waiting period is a critical concern. This study evaluated the clinical and pathological responses to neoadjuvant paclitaxel, carboplatin, and cetuximab (PCE) therapy used as a "bridging therapy" to ensure safe transition to surgery.

This retrospective study included 22 patients with resectable locally advanced HNSCC treated with neoadjuvant PCE followed by radical surgery. Clinical response was assessed using RECIST v1.1, and pathological response was evaluated using the Mandard tumor regression grade (TRG) system. The correlation between radiological and pathological findings and their impact on survival [disease-free survival (DFS) and overall survival (OS)] were analyzed.

The disease control rate was 100%, and the objective response rate was 41%. Pathological evaluation revealed TRG 1-2 in 10 patients and TRG 3-5 in 12 patients. There was no significant correlation between radiological response and pathological response (p=0.202); notably, 33.3% of radiological PR cases exhibited extensive residual disease (TRG 4). As the study was not powered to detect survival differences, survival analysis showed no significant differences in DFS or OS based on either radiological or pathological response (all p>0.50). No surgical procedures were cancelled or delayed due to treatment-related toxicities.

Neoadjuvant PCE therapy is a feasible and manageable bridge to surgery for locally advanced HNSCC, ensuring high surgical completion rates without compromising safety. However, a significant discordance exists between imaging and pathology, suggesting that radiological shrinkage should not be used as a rationale for surgical de-escalation. Radical resection should proceed according to the original tumor extent regardless of the clinical response to ensure oncological safety.