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

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.