A retrospective analysis of patients diagnosed with head and neck squamous cell carcinoma at a National Cancer Institute-designated cancer center between 1998–2019 was performed . 50.6% of recurrences occurred within 6 months of treatment completion, 72.5% occurred in 1 year, 88.8% within 2 years . Oligometastatic disease treated with local ablative therapy was associated with improved survival . Metachronous distant metastases were more likely to occur in patients with HPV-positive disease (odds ratio [OR], 2.3 [1.4–4.0]), DFI >6 months (OR) and body mass index .