Objective:

To identify existing subjective and objective RIF measurement tools used in HNC and evaluate their reported reliability and validity.

Approach:

• Search Strategy: A comprehensive literature search was conducted across multiple electronic databases using a combination of Medical Subject Headings (MeSH) and natural language terms related to 'radiation fibrosis' and 'head and neck cancer'.
• Screening and Eligibility Criteria: Two independent reviewers screened titles and abstracts for relevance to RIF measurement tools, followed by full-text screening using predefined eligibility criteria.
• Data Extraction and Synthesis: Data from included studies were extracted and synthesized descriptively, summarizing key characteristics and outcomes.

Key Findings:

• The cumulative incidence of severe subcutaneous fibrosis has been reported to exceed 40% at 10 years in patients with prior neck dissection or high radiation doses.
• There is no consensus on a valid, reliable, and non-invasive tool for assessing RIF in HNC patients.
• Assessment tools for fibrosis include subjective PROMs and clinician-based palpation grading scales, as well as objective imaging-based techniques.

Interpretation:

The review highlights a critical gap in the literature regarding the assessment of RIF, despite the development of numerous tools since the last systematic review in 2016.

Limitations:

• The review is limited to studies published in English.
• Exclusion of non-original research articles may limit the comprehensiveness of the findings.

Conclusion:

The review underscores the need for reliable and valid tools to assess fibrosis in HNC survivors.