# 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.

## Key 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.