- Design
- Systematic review and random-effects meta-analysis of 26 mostly retrospective studies
- Population
- 3133 adults treated with radiotherapy for mucosal head and neck cancer
- Primary outcome
- Prevalence of lymphoedema
- Effect
- 49% (95% CI 36% to 62%); grade 2 or worse 32%
A systematic review of 26 studies (3133 adults) estimated how often lymphoedema follows radiotherapy for mucosal head and neck cancer. The pooled prevalence was 49% (95% CI 36% to 62%), with internal lymphoedema — of the pharynx and larynx — in 45% and external lymphoedema of the face and neck in 37%. Where severity was graded, 32% had grade 2 or worse.
The evidence is weak: definitions and assessment varied, most studies were retrospective and single-arm, heterogeneity was very high (I² = 94%), and certainty was very low. Even so, the signal is consistent: this is a common late effect, not a rare one.
Internal lymphoedema can worsen swallowing and voice and is easily missed without endoscopy. Survivorship follow-up should look for it deliberately and refer early.
- Ask about neck swelling, facial fullness, swallowing and voice changes at every survivorship visit after head and neck radiotherapy.
- Look for internal lymphoedema on endoscopy, not only external swelling on examination.
- Refer early to lymphoedema therapy where available; manual lymphatic drainage and compression are the mainstays.
- Record a baseline neck examination before radiotherapy so later change can be judged.
Why it matters
A late effect seen in half of survivors is often unrecorded because no one looks for it.
Don't overread it
Certainty was very low and definitions varied; the true prevalence could be well above or below 49%.
The statistics, in plain English
A pooled prevalence of 49% with an interval of 36% to 62% means somewhere between a third and two-thirds of patients. An I² of 94% means studies differed greatly, largely because they defined and measured lymphoedema differently.
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