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Therapeutic Interventions for Radiation-Induced Fibrosis in Head and Neck Cancer Patients: A Systematic Review
Pooja D Reddy1, Purva Rumde1, Vanessa Helou2
1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Objective:
To review and evaluate treatments for radiation-induced fibrosis (RIF) following head and neck cancer (HNC) therapy.
Data Sources:
Medline, Embase.com, Web of Science, and Cochrane Library.
Review Methods:
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.
Results:
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).
Conclusion:
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.
