- Design
- Systematic review and meta-analysis of prevalence
- Population
- 3,133 adults after radiotherapy for mucosal head and neck cancer, 26 studies
- Primary outcome
- Prevalence of lymphoedema
- Effect
- 49% (36-62%); grade 2 or worse 32% (14-59%)
This systematic review and meta-analysis pooled 26 studies, 3,133 adults treated with radiotherapy for mucosal head and neck cancer, published 2000 to 2025. Most were retrospective single-arm series.
Pooled prevalence of lymphoedema was 49% (95% CI 36% to 62%). External lymphoedema of the face and neck was found in 37%, and internal lymphoedema of the pharynx and larynx in 45%. Where severity was graded, about 32% had clinically significant (grade 2 or worse) disease. Heterogeneity was very high (I² 94%), definitions varied, and certainty was rated very low.
The exact figure is uncertain, but even the lower bound means lymphoedema is common, not an occasional complication. Internal lymphoedema can worsen swallowing and voice, and is easily mistaken for recurrence or simply missed. Few Indian centres have dedicated head and neck lymphoedema therapists, so recognising it in follow-up clinic is the first step.
- Examine for facial, submental and neck swelling at every post-radiotherapy follow-up.
- Look for internal oedema of the epiglottis, arytenoids and pharyngeal walls on endoscopy.
- Consider internal lymphoedema when swallowing or voice worsens without evidence of recurrence.
- Refer early for lymphoedema therapy where available; manual drainage and compression are the mainstays.
Why it matters
Lymphoedema is common enough after radiotherapy to need a routine check, not an afterthought.
Don't overread it
Very low certainty, with inconsistent definitions; the true prevalence could be well below or above half.
The statistics, in plain English
An I² of 94% means almost all the variation between studies reflects real differences in patients, definitions or methods, not chance, so the pooled 49% is an average across very different settings.
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