Age-stratified clinical interpretation of AWGS2025 sarcopenia criteria in head and neck cancer treated with definitive chemoradiotherapy: Comparison with AWGS2019.

OBJECTIVE

The AWGS2025 update extends sarcopenia diagnosis to adults aged 50-64 years, requires concurrent low muscle mass and low muscle strength, and introduces BMI-stratified muscle mass thresholds. We aimed to examine how these changes alter case identification in patients with head and neck cancer (HNC) undergoing definitive chemoradiotherapy (CRT).

METHODS

We retrospectively analyzed 97 consecutive patients with HNC who underwent pretreatment assessment before definitive CRT. AWGS2025 was applied to patients aged ≥ 50 years, and AWGS2019 and AWGS2025 were cross-classified in those aged ≥ 65 years. We compared agreement, treatment selection, cisplatin completion, and selected acute toxicities in age-stratified analyses.

RESULTS

Among patients aged ≥ 65 years (n = 55), sarcopenia prevalence was 23.6% by AWGS2019 and 20.0% by AWGS2025, with substantial agreement (κ = 0.79). In older adults, discordance was driven mainly by removal of physical performance from the diagnostic algorithm. Among triCDDP-treated older adults, the clearest acute-toxicity signal in sarcopenic patients was grade ≥ 3 radiation dermatitis. AWGS2025 additionally classified 6/35 (17.1%) patients aged 50-64 years as sarcopenic. In this small subgroup, treatment intensity and selected acute toxicities were not clearly increased.

CONCLUSION

In HNC treated with definitive CRT, AWGS2025 represents an age-stratified diagnostic reclassification rather than a replacement for AWGS2019. In older adults, an AWGS2025 diagnosis may identify patients at increased risk of selected acute toxicities, particularly severe radiation dermatitis, whereas its clinical meaning in middle-aged adults remains exploratory.