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Video

Head and Neck Surgery

(A576) Measuring Up: Systematic Review of Measurement Tools for Fibrosis in Head and Neck Cancer Patients

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters
Disclosure(s):
Vanessa Helou, MD: No relevant relationships to disclose.
Pooja D. Reddy, BS: No relevant relationships to disclose.
Marci L. Nilsen, PhD, RN, CHPN, FAAN: No relevant relationships to disclose.
Kevin J. Contrera, MD, MPH: No relevant relationships to disclose.


Introduction: Long-term radiation-induced fibrosis is a common and debilitating late side effect of head and neck cancer (HNC) treatment, significantly impacting patients’ quality of life. Despite advancements in subjective and objective measurement tools to assess long-term fibrosis severity in these patients, there is still a critical need for an updated systematic review to evaluate their reliability, validity, and clinical utility.

Methods: Cochrane Library, Medline, Embase.com, Web of Science were systematically searched. Articles pertaining to measurement tools for post-radiation induced fibrosis in HNC patients were selected for independent review by three raters using the COnsensus-based Standards for selecting health Measurement INstruments (COSMIN) checklists for risk of bias (ROB) assessment. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results: Out of 4078 articles, 17 studies reported measurement tools for post HNC fibrosis, of which 10 describe imaging tools, two describe physician-reported outcome measures, and five describe patient-reported outcome measures (PROMs). Out of the PROMs, the Neck Fibrosis Scale (NFS) tool, HN-LEF-SI, and CTCAE adapted LENT-SOMA demonstrated validity and reliability, but only the NFS focuses exclusively on fibrosis symptom measurement. The physician-reported HN-ELAF scale also demonstrated both validity and reliability. All PROM and physician-reported outcome tools were ‘adequate’ for ROB. Out of the imaging tools, Young’s modulus showed both validity and reliability, while shear wave elastography and MRI only demonstrated reliability. All imaging tools were at risk for bias.

Conclusions: Multiple subjective measurement tools (NFS, HN-LEF-SI, CTACE adapted LENT-SOMA, and HN-ELAF) for post-radiation fibrosis in patients with HNC are reliable and valid. To date, Young’s modulus is the only reliable and valid objective fibrosis measurement tool described in these patients.