Pediatric Head and Neck Squamous Cell Carcinoma: Patient Demographics, Treatment Trends, and Outcomes

Abstract

Head and neck squamous cell carcinomas (HNSCC) are common in adults but considered rare in the pediatric population. However, there is evidence of a rising incidence of pediatric head and neck cancer, which is of concern considering little is known about pediatric HNSCC. There are few standards regarding appropriate management and care of these patients, and most approaches have been extrapolated from adult HNSCC management. The purpose of this study was to examine patient demographics, temporal and treatment trends, and survival outcomes of pediatric non-nasopharyngeal HNSCC using the National Cancer Database The NCDB was queried for pediatric patients (age 0-19 years) diagnosed with non-nasopharyngeal HNSCC (including oral cavity, oropharynx, nasal cavity, larynx, hypopharynx, and salivary glands) from 2004 to 2013. Patients with incomplete or missing follow-up were excluded. Patient demographics and treatment characteristics were evaluated. Linear regression was used to evaluate the trends in the number of cases by year of diagnosis. Kaplan-Meier plots for overall survival (OS) were generated and log-rank tests were used to evaluate outcomes across the cohort and stratified by subsite. Of 159 patients identified, there was a male predominance (61%) with a median age of 17 years. The majority of patients had disease in the oral cavity (55%). Stage IV was the most common (33%). There was no discernable change in incidence trends over the study period with the number of cases per year ranging from 10-20 (R2 = 0.174). The 5-year OS for the entire cohort was 74% and by subsite: oral cavity (66%), oropharynx (68%), nasal cavity (75%), and larynx/hypopharnx (95%). Laryngeal/hyphopharyngeal disease had statistically significant longer survival when compared to the oral cavity (p = 0.031) or oropharynx (p = 0.029). The predominant treatment regimen for the oral cavity and nasal cavity was trimodality (surgery, radiation, and chemotherapy) treatment (33% and 29%, respectively), chemotherapy and radiation for the oropharynx (40%), surgery alone for salivary gland (47%) and larynx/ hypopharynx (22%). We present one of the largest series of pediatric non-nasopharyngeal HNSCC. The number of cases remained steady over the 10-year study period. While treatment patterns were comparable to those of their adult counterparts, survival outcomes were better in the pediatric population when considering historical controls.