The clinical situation of coexisting significant cardiac arrhythmias complicating head and neck cancer (HNC) is uncommon, accounting for <11% of comorbid illnesses present in this particular cohort of individuals. Little is documented about the outcomes of these people with cardiac pacemakers (CP) when surgery combined with postoperative radiotherapy is rendered. The authors report two cases wherein full-course postoperative irradiation was administered without any patient mishap. Appropriately indicated adjuvant radiotherapy for locally advanced HNC can be conducted safely and effectively in patients with CPs. Implementation of essential precautionary measures is encouraged to avoid any serious, unwanted cardiac events.