Purpose: The present study is aiming to correlate between different radiotherapy techniques, fractionations and doses received by each axillary LN level and axillary vessels with the development of breast cancer related lymphedema (BCRL). Methods and materials: We retrospectively studied 181 female breast cancer patients who were diagnosed and treated by radiation therapy during the period from January 2012- December 2017. The radiotherapy treatment plans were recalled from the archives. The axillary LN levels I, II, III, supraclavicular LN were contoured as well as axillary vessels. New dose volume histograms (DVHs) were generated to correlate between the radiotherapy dose t and the development of BCRL. Results: The study included 162 patients treated with 3D radiotherapy technique and 19 treated with 2D technique radiotherapy. 124 patients underwent MRM while 57 patients underwent BCS. 117 patients treated with hypofractionated technique while 64 patients treated with conventional radiotherapy technique . The cumulative incidence of BCRL after radiotherapy was 20.4%. There was a statistically significant relation between 2D radiotherapy technique compared with 3DCRT and development of lymphedema 55% vs 16.6% respectively(p<0.001). Patients who were treated with conventional radiotherapy had significantly higher rates of lymphedema (42.2%) compared with hypofractionated radiotherapy (8.5%) (p<0.001). There was non-significant relation between mean radiotherapy dose to axillary levels or the axillary vessels and development of lymphedema. Conclusion Breast cancer radiotherapy with 2D technique and conventional fractionation protocol might increase the risk of BCRL. No correlation was observed between radiotherapy dose to each axillary LN level, axillary vessels and BCRL.

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