Measurement Tools for Radiation-Induced Fibrosis in Head and Neck Cancer: A Systematic Review

Authors

• Vanessa Helou, University of Pittsburgh School of Medicine, Pittsburgh, PA
• Pooja D. Reddy, University of Pittsburgh School of Medicine, Pittsburgh, PA
• Purva H. Rumde, University of Pittsburgh School of Medicine, Pittsburgh, PA
• Mary L. Klem, University of Pittsburgh, Pittsburgh, PA
• Sagar G. Kansara, LSU Health Sciences Center - New OrleansFollow
• Oldrich Virag, University of Pittsburgh School of Medicine, Pittsburgh, PA
• Yvonne M. Mowery, UPMC Hillman Cancer Center, Pittsburgh, PA
• Nicole N. Scheff, University of Pittsburgh, Pittsburgh, PA
• Matthew E. Spector, University of Pittsburgh School of Medicine, Pittsburgh, PA
• Shaum Sridharan, University of Pittsburgh School of Medicine, Pittsburgh, PA
• Marci L. Nilsen, University of Pittsburgh School of Medicine, Pittsburgh, PA
• Kevin J. Contrera, University of Pittsburgh School of Medicine, Pittsburgh, PA

Document Type

Article

Publication Date

7-2-2026

Publication Title

Head & Neck

Abstract

BACKGROUND: Radiation-induced fibrosis is a common, often debilitating late effect of head and neck cancer (HNC) treatment. An updated systematic review is needed to evaluate the reliability, validity, and clinical utility of fibrosis measurement tools. METHODS: Cochrane Library, Medline, Embase.com, and Web of Science were systematically searched. Articles were independently screened by two reviewers using COSMIN checklists for risk of bias assessment, following PRISMA guidelines. RESULTS: Of 4678 articles, 17 studies describing 13 tools met inclusion: six studies assessed four patient-reported outcome measures, two assessed two clinician-reported tools, and nine assessed seven imaging modalities. The Neck Fibrosis Scale, HN-LEF Symptom Inventory, and LENT-SOMA demonstrated validity and reliability. Young's modulus was the only imaging tool demonstrating both. Imaging studies had a higher risk of bias. CONCLUSION: Several subjective tools are reliable and valid for radiation-induced fibrosis assessment in HNC. Young's modulus is the only objective imaging-based tool that provides evidence of both validity and reliability, though methodological limitations remain.

First Page

1

Last Page

13

PubMed ID

42392995

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Recommended Citation

Helou, Vanessa; Reddy, Pooja D.; Rumde, Purva H.; Klem, Mary L.; Kansara, Sagar G.; Virag, Oldrich; Mowery, Yvonne M.; Scheff, Nicole N.; Spector, Matthew E.; Sridharan, Shaum; Nilsen, Marci L.; and Contrera, Kevin J., "Measurement Tools for Radiation-Induced Fibrosis in Head and Neck Cancer: A Systematic Review" (2026). School of Medicine Faculty Publications. 5022.
https://digitalscholar.lsuhsc.edu/som_facpubs/5022
10.1002/hed.70380