Head and neck squamous cell carcinoma in adults aged 45 or younger—an analysis of two tertiary cancer centres

Purpose The aim of this study was to evaluate the outcome, especially disease-free survival (DFS) and recurrence patterns, in patients with a maximum age of 45 years at first diagnosis of head and neck squamous cell carcinoma (HNSCC). Methods We retrospectively reviewed data from 79 patients with newly diagnosed HNSCC aged 45 or younger without distant metastasis who underwent postoperative or definitive radio(chemo)therapy in either the Department of Radiation Oncology at the University Hospital of Erlangen or the Department of Radiation Oncology at the University Hospital of Mainz between September 2006 and December 2023. The Kaplan–Meier method was used to calculate survival and recurrence rates. In univariate analysis, the log-rank test was used to correlate patient-/tumour- and treatment-related parameters to survival and recurrence rates. Results The overall survival rate was 79.7% at 2 years and 67.1% at 5 years. The DFS rate was 73.4% at 2 years and 67.1% at 5 years. Cumulatively, 14.6% of patients in the postoperative arm had locoregional recurrences at 2 years and 23.0% at 5 years, while 25.7% of patients in the definitive arm had local recurrences at 2 years and 33.1% at 5 years ( p = 0.36). The rate of distant metastasis was 19.2% in the postoperative arm at 2 years and 21.6% at 5 years. In the definitive arm, the distant metastasis rate was 20.7% at 2 years and 28.6% at 5 years ( p = 0.49). Disease-free survival was significantly improved in patients who drank little or no alcohol ( p = 0.005) and in patients with a low UICC stage ( p < 0.001). No differences in DFS were observed for different primary tumour locations or treatment modalities. Conclusion Locoregional recurrences were the most common site of recurrence, regardless of tumour location and treatment modality. Therefore, future study designs in this patient cohort should potentially investigate intensified treatment approaches.