Radiation-induced fibrosis in head and neck cancer survivors: long-term sequelae and multimodal management

Introduction Improved survival in head and neck cancer has increased the number of patients living with late effects of treatment, among which radiation-induced fibrosis is a progressive and often irreversible complication with important consequences for pain, function, and quality of life. In addition to contributing to trismus, dysphagia, speech impairment, and reduced cervical mobility, fibrosis has important implications for airway management and perioperative care. Methods This narrative review synthesizes current clinical and translational literature on radiation-induced fibrosis in head and neck cancer survivorship, with emphasis on its epidemiology, underlying mechanisms, clinical manifestations, diagnosis, prevention, management, emerging therapies, and multidisciplinary care, while highlighting functional outcomes and anesthesia-relevant airway sequelae. Results Radiation-induced fibrosis may emerge months to years after treatment and is driven by persistent inflammatory and profibrotic signaling that promotes tissue remodeling and long-term dysfunction. Risk is influenced by patient and treatment factors including smoking, concurrent chemoradiotherapy, radiation dose and field design, surgical dissection, and baseline functional impairment. Clinically, fibrosis contributes to restricted neck motion, trismus, dysphagia, aspiration risk, dysphonia, chronic pain, and psychosocial burden. Current management is largely multimodal and supportive, centering on rehabilitation, speech and swallow therapy, symptomatic pharmacological treatment, interventional pain procedures, and selective surgery. Emerging strategies, such as antifibrotic agents, mesenchymal stromal cell therapies, hyperbaric oxygen, and candidate biomarker strategies, remain investigational but may expand future treatment options. Discussion Radiation-induced fibrosis is an underrecognized survivorship challenge that extends beyond tissue scarring to long-term dysfunctions across airway, swallowing, pain, and quality of life domains. Future progress will depend on standardized diagnostic criteria, earlier detection, prevention-focused trials, continued evaluation of investigational therapies, and patient-centered outcomes that better capture the lived burden of survivors and guide more precise supportive care.