Lymphedema therapy in head & neck cancer with carotid stenosis: a systematic review and care pathway

Head and neck cancer (HNC) survivors treated with radiation therapy are at increased risk for both lymphedema and carotid artery atherosclerosis. The coexistence of these conditions creates complex management challenges, yet no clinical practice guidelines currently address this overlap. This report aims to develop a preliminary clinical care pathway to guide lymphedema treatment in irradiated HNC survivors at risk for carotid atherosclerosis.

A comprehensive literature search was conducted in June 2023 and updated in September 2025 using three primary MeSH components: head and neck cancer, lymphedema therapy, and atherosclerosis. Searches were performed across PubMed, Embase, and CINAHL, along with relevant professional organization resources. A multidisciplinary working group-including experts in radiation oncology, preventive cardiology, rehabilitation, and lymphedema management-reviewed the evidence and developed a proposed care pathway.

The search identified 85 unique articles. After title and abstract screening, one article underwent full-text review; however, none directly addressed lymphedema management in irradiated HNC survivors at risk for carotid atherosclerosis. To address this gap, the working group developed a preliminary clinical care pathway based on the available evidence and expert consensus.

This pathway represents an initial effort to guide the management of lymphedema in irradiated HNC survivors with coexisting cardiovascular risk. It integrates limited published evidence with multidisciplinary clinical expertise in oncology, cardiovascular risk assessment, and lymphedema care. Further validation and refinement are needed to support clinical implementation.