Clinicopathological Review of Head and Neck Squamous Cell Carcinomas After Neoadjuvant Chemotherapy

Background/Aim: The benefit of neoadjuvant chemotherapy (NAC) in the treatment of head and neck squamous cell carcinoma (HNSCC) remains unclear. Patients and Methods: We retrospectively collected 30 patients with HNSCC who had undergone radical resection after NAC. We pathologically evaluated the therapeutic response to NAC, and classified the residual tumor patterns. In addition, we compared the maximum horizontal diameter on pathology with imaging. Results: The residual patterns were categorized as follows: 10 cases of shrunken type, 11 cases of mixed type, and seven cases of fragmented type. The majority of underestimation cases – those cases in which the maximum horizontal diameter measured on post-NAC imaging was less than the pathological size after resection – were multifocal residual lesions, with a tendency for more frequent “positive” or “close” surgical margins. Conclusion: The strategy of performing NAC to reduce resection volume is not appropriate, and resection margins should be based on the assessment before NAC.