title: Valid and reliable techniques for measuring fibrosis in patients with head and neck cancer postradiotherapy: A systematic review.
abstract: Fibrosis is a common side effect of radiotherapy for head and neck cancer. Although treatments for fibrosis have been developed, valid and reliable measurement tools are needed to verify their efficacy. The purpose of this review was to identify and appraise tools used to measure head and neck fibrosis.
  
  
  
  Electronic databases were searched for primary research published through April 2014. Main search terms included head and neck cancer, radiotherapy, fibrosis, validity, and reliability. Methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Two blinded raters conducted all assessments. Discrepancies were resolved by consensus.
  
  
  
  The search retrieved 534 unique citations. Nine studies met our inclusion criteria, representing 9 different tools. Only 1 tool was assessed for reliability and validity. QUADAS-2 revealed that all studies were at risk for bias.
  
  
  
  To date, there are no valid and reliable techniques for measuring fibrosis postradiotherapy for head and neck cancer, especially within the suprahyoid and pharyngeal regions. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2322-E2334, 2016.
authors.affiliation: Department of Speech-Language Pathology, University of Toronto, Ontario, Canada.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Shaw
authors.affiliation: Department of Speech-Language Pathology, University of Toronto, Ontario, Canada.|Mazankowski Alberta Heart Institute, Alberta Health Services, Alberta, Canada.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Skoretz
authors.affiliation: Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Ontario, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.affiliation: Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hope
authors.affiliation: Division of Gastroenterology, Department of Medicine, Toronto Western Hospital, University Health Network, Ontario, Canada.
authors.forename: Louis W C
authors.initials: LW
authors.lastname: Liu
authors.affiliation: Department of Speech-Language Pathology, University of Toronto, Ontario, Canada.|Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Ontario, Canada.|Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Ontario, Canada.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Martino
mesh_terms: D005355:Fibrosis / Q000175:diagnosis* / Q000473:pathology; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D011878:Radiotherapy / Q000009:adverse effects; D015203:Reproducibility of Results
keywords: fibrosis; head and neck cancer; measurement; radiotherapy; reliability; validity