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

Authors

Muniba Alim, Shamila Alim, Shahid Siddiqui

Published in

Journal of cancer research and therapeutics. Volume 22. Issue 5. Pages 832-841. Jul 01, 2026. Epub Oct 29, 2026.

Abstract

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

PMID:
42955963
Bibliographic data and abstract were imported from PubMed on 30 Oct 2026.

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