DOI: 10.4103/jcrt.jcrt_2242_25 ISSN: 1998-4138

Postoperative radiotherapy in pediatric versus adult head and neck malignancies: A two-center analysis of survival outcomes and age-specific late effects

Muniba Alim, Shamila Alim, Shahid Siddiqui
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ABSTRACT

Background:

Head and neck malignancies represent <10% of pediatric cancers, but require intensive multimodal treatment including postoperative radiotherapy (RT), posing unique risks for lifelong late effects impacting quality of life.

Objectives:

To evaluate survival outcomes, toxicity profiles, and recurrence patterns in pediatric versus adult head and neck cancer patients receiving postoperative RT, and characterize age-specific late effects.

Methods:

This retrospective cohort study analyzed 519 patients from two Indian tertiary centers (2010–2023): 27 pediatric (<18 years), 88 young adults (18–39 years), and 404 older adults (≥40 years) receiving surgery followed by adjuvant RT ± chemotherapy. Endpoints included disease-free survival (DFS), overall survival (OS), toxicity, and recurrence patterns, analyzed using Kaplan-Meier estimates, Cox regression, and competing risk analysis.

Results:

Despite predominantly advanced-stage disease (74%–81% Stage III-IV), survival outcomes were comparable. Two-year DFS rates were 62% (pediatric), 64% (young adults), and 61% (older adults, P = 0.88); 2-year OS rates were 68%, 70%, and 67% ( P = 0.85). Kaplan-Meier curves showed overlapping trajectories without age-based separation. Age was not an independent prognostic factor (HR 1.02, P = 0.93), while advanced stage, positive margins, and extracapsular extension significantly predicted outcomes. Acute toxicity rates were similar (grade 2–3 mucositis: 74%–80%, P = 0.65). However, chronic effects affected 70.4% of pediatric survivors versus 42.0–48.5% of adults ( P = 0.02), including facial growth disturbances (33.3% vs. 2.0–8.0%), dental abnormalities (48.1% vs. 11.1–15.9%), endocrinopathies (44.4% vs. 14.8–15.1%), and neurocognitive impairment (29.6% vs. 3.2%–6.8%, all P < 0.001).

Conclusion:

Postoperative RT achieves comparable disease control, but disproportionate chronic late effects in > 70% of pediatric survivors necessitate age-adapted treatment strategies and survivorship care.

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