Therapeutic Interventions for Radiation-Induced Fibrosis in Head and Neck Cancer Patients: A Systematic Review.

Abstract

To review and evaluate treatments for radiation-induced fibrosis (RIF) following head and neck cancer (HNC) therapy. Medline, Embase.com, Web of Science, and Cochrane Library. A systematic review was conducted on the management of HNC RIF using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Descriptive synthesis was conducted to summarize treatment efficacy. After initial screening of 4078 titles and abstracts, 147 full-text articles were reviewed, with eight meeting inclusion criteria. Pharmacological interventions included pentoxifylline-tocopherol, pravastatin, amifostine, and topical superoxide dismutase (SOD). Pentoxifylline-tocopherol, pravastatin, and amifostine demonstrated variable fibrosis improvement rates across studies. In one uncontrolled trial, 83% of patients receiving pentoxifylline-tocopherol achieved ≥50% reduction in measured fibrotic surface area, and pravastatin reduced fibrosis thickness by ≥30% in 35.7% of patients. Procedural interventions included lipotransfer and microcurrent therapy, with lipotransfer associated with physical improvements in 97% of patients (n = 38) and microcurrent therapy enhancing cervical mobility in 92% of patients (n = 26). Improvements in HNC fibrosis after current treatments ranged widely across studies; however, substantial heterogeneity in study design and outcome measurement limits definitive conclusions regarding comparative effectiveness.