This systematic review, published on 11 September, screened 4,078 records and found only eight studies of treatments for radiation-induced fibrosis after head and neck cancer. Drug treatments were pentoxifylline with tocopherol, pravastatin, amifostine and topical superoxide dismutase; procedures were fat grafting and microcurrent therapy.
In one uncontrolled trial, 83% of patients on pentoxifylline with tocopherol had at least a halving of fibrotic area, and pravastatin reduced fibrosis thickness by 30% or more in about a third. Fat grafting (38 patients) and microcurrent therapy (26 patients) reported high improvement rates. Designs and outcome measures varied too much to compare treatments.
For survivors with neck stiffness and trismus, there is no proven treatment beyond physiotherapy, and this review does not change that. It does describe options worth discussing within a specialist survivorship service.
- Refer survivors with neck stiffness or trismus to physiotherapy early.
- Consider pentoxifylline with tocopherol only as a discussed, off-label option in specialist hands.
- Measure fibrosis and neck range before and after any treatment.
- Screen for fibrosis at survivorship follow-up rather than waiting for complaints.
Why it matters
A common, disabling late effect of treatment still has almost no controlled evidence behind any therapy.
Don't overread it
The high response rates come from small uncontrolled studies.
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