8.4.2 Advanced Radiotherapy Injury
（1）Lymph edema of the upper limb of the affected side
Lymphedema is associated with axillary surgery and radiation therapy.After simple axillary lymph node dissection，about 10%of patients will have ipsilateral upper extremity edema.In the simple axillary radiotherapy，6%of patients will have ipsilateral upper extremity edema.Surgery plus axillary radiotherapy will increase the incidence of upper extremity edema to 31%.Mainly for prevention，no specific drugs.
（2）brachial plexus injury
Most occur after high-dose clavicle or axillary lymphatic drainage area.The incidence of brachial plexus injury is related to the total dose and division.The conventional supraclavicular area is 50Gy，and the incidence of brachial plexus injury is less than 1%at 2Cy/once.Therefore，clinically，patients with brachial plexus injury after the prevention of radiation dose should first be excluded from other causes，such as tumor recurrence.
Brachial plexus TD5/5 is 60Gy，that is，when the irradiation dose is 60Gy，5%of patients will have brachial plexus injury within 5 years after radiotherapy.Mainly for prevention，no specific drugs.
（3）ischemic heart disease(https://www.daowen.com)
Early studies have found that patients with left breast cancer will be exposed to some heart and coronary arteries during radiotherapy，which will cause heart damage after radiotherapy.After 10 to 15 years of radiotherapy，the left side is more ischemic than the right breast cancer patient.Increasing mortality has offset the survival benefits of radiation therapy.With the improvement of radiotherapy technology，the mortality rate of heart disease decreased with the age of treatment，indicating that the risk of heart disease death caused by radiotherapy is gradually decreasing with modem radiotherapy technology.
（4）Breast cosmetic effect
Breast-conserving surgery patients should regularly evaluate breast cosmetic effects after radiotherapy.Breast cosmetic effects are related to patients，surgery，radiotherapy，and chemotherapy.
（5）Other
Subcutaneous tissue fibrosis，telangiectasia，radiation pulmonary fibrosis，rib fracture，second primary tumor such as lung cancer，contralateral breast cancer，sarcoma，etc.
（Li Wang）