Radiotherapy outcomes and risk factors for young patients with head-and-neck squamous cell carcinomas: a matched-pair analysis

TL;DR

Young patients with head-and-neck cancer have similar survival outcomes as older patients after radiotherapy, but face higher mortality risks compared to the general population.

Contribution

This study provides matched-pair analysis of young HNSCC patients treated with (chemo)radiotherapy, revealing similar survival outcomes but higher excess mortality risk.

Findings

Median overall survival for young HNSCC patients was 63 months.

Daily alcohol consumption was a key risk factor for reduced survival in young patients.

Chronic toxicities in young patients were moderate, with no significant differences in progression-free or metastasis-free survival.

Abstract

Head-and-neck squamous cell carcinomas (HNSCC) exhibit significant variations in incidence and outcomes across age groups. There is conflicting data on the oncological outcomes of younger HNSCC patients ≤ 45 years. This study analyzed clinical characteristics, treatment-related toxicities and survival rates of young HNSCC patients treated with (chemo)radiotherapy.

HNSCC patients ≤ 45 years treated with radiotherapy between 2009 and 2021 at two large cancer centers were analyzed and matched to a patient cohort > 45 years based on TNM and tumor localization. Overall (OS), progression-free (PFS) and metastasis-free (DMFS) survival and locoregional control (LRC) were compared and treatment-related toxicities were assessed.

99 patients were included in this analysis. Median OS of the young HNSCC cohort was 63 months. Daily alcohol consumption was identified as a key risk factor for reduced OS in the multivariate analysis. OS was similar in the young cohort compared to older patients, although the excess mortality risk compared to the sex- and age-matched general population amounted to 59-fold, while it was only 5.9-fold for patients ≥ 45 years. No significant differences were observed in PFS, LRC, or DMFS between age groups. Higher-grade chronic toxicities were moderate in young HNSCC patients.

Young HNSCC patients ≤ 45 years treated with (chemo)radiation have similar rates of oncological survival outcomes compared to older patients. While chronic toxicities from (chemo)radiation are low, further research is needed to explore the long-term quality-of-life.

The online version contains supplementary material available at 10.1186/s13014-025-02631-w.

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