Normal tissue complication probability modeling of radiation-induced neck fibrosis in head and neck Cancer survivors: a patient-reported outcome-based analysis.
15.6% of head and neck cancer survivors reported severe neck fibrosis symptom burden
Normal tissue complication probability modeling of radiation-induced neck fibrosis in head and neck Cancer survivors: a patient-reported outcome-based analysis.
Skin and soft tissue fibrosis of the neck is a common late toxicity after head and neck radiotherapy (Muehlebach et al., 2025; Ramia et al., 2022; Strojan et al., 2017 [1], [2], [3]), yet no dedicated patient-reported outcome (patient-reported outcome) instrument exists to capture its specific functional and quality-of-life (QOL) impact.
In an IRB-approved prospective trial, 95 patients in remission after curative-intent head and neck radiotherapy completed the EORTC QLQ-C30, QLQ-H&N43, and the 22-item Scleroderma Skin Patient-Reported Outcome (Scleroderma Skin Patient-Reported Outcome) instrument. [7], [8], [9] Neck organs at risk (organs at risk) constituting skin, subcutaneous tissue, and sternocleidomastoid (sternocleidomastoid) muscle were retrospectively contoured; dose-volume metrics are analyzed using Lyman-Kutcher-Burman (Lyman-Kutcher-Burman) normal tissue complication probability modeling.
nearly 1 in 6 survivors had fibrosis symptoms severe enough to impair quality of life
All 95 patients completed Scleroderma Skin Patient-Reported Outcome, QLQ-C30, and QLQ-H&N43.
Correlation analyses showed moderate-to-strong associations between Scleroderma Skin Patient-Reported Outcome and established QOL instruments.
In non-surgical patients, higher mean dose and selected V_x metrics to skin, sternocleidomastoid, and subcutaneous tissue were positively associated with worsening Scleroderma Skin Patient-Reported Outcome scores, whereas no robust dose-response was seen in surgically treated patients.
Scleroderma Skin Patient-Reported Outcome captures neck fibrosis-related QOL impairment that is incompletely reflected by standard head and neck QOL instruments.
patient-reported outcome-anchored normal tissue complication probability modeling suggests that dose to skin, sternocleidomastoid, and subcutaneous tissue predicts fibrosis-related patient-reported outcome deterioration in non-surgical patients.
Eisbruch et al. (1999, 2004), Murdoch-Kinch et al. (2008), Nutting et al.