: The aim of this study was to assess the impact of the COVID-19 pandemic on the adequacy between treatment decisions made in multidisciplinary team meetings (MTMs) and therapy administered to patients with upper aerodigestive tract cancers. Secondary aims included assessing treatment administration times at different periods and identifying factors explaining discrepancies. : A retrospective, monocentric study was conducted at a university hospital center from 2019 to 2021, including 475 first-line patients. Patients were divided into two groups: those with matching treatments (MTMs vs. delivered) and those with discrepancies. Alignment between treatment decision and treatment delivery was compared among the three periods (before, during, and after the COVID-19 pandemic), and factors influencing non-alignment were analyzed using univariate and multivariate analysis. : Of the 475 patients, 106 (23%) received treatments differing from MTM decisions. The pandemic period saw more advanced cancers (4.8% metastatic in 2019 vs. 12% in 2020), poorer general condition, and undernutrition. The pandemic did not significantly affect treatment matching ( = 0.4). Factors linked to mismatches included worse general condition (PS ≥ 2, < 0.001) and more locally advanced tumors (T3/4, = 0.002). Shorter processing times were noted during the pandemic and post-pandemic periods. : Despite more advanced cancers and poorer general condition, patients treated during the pandemic had continuous care and similar treatment alignment as before. This study shows the effectiveness of ongoing care during the pandemic, ensuring treatment adherence.