<b>LIMB</b>

Late radiation edema of the extremities may develop after therapy of malignancies. It is associated with radiation damage of lymph and veins, and with scarring of tissues in the radiation zone, which can result in muscle atrophy. Serious late radiation damage, such as grave functional deficiency, and/or painful scarring or contractures, might require amputation later. Bone damage can also occur. The generalized late effect risks of New Cancer and Bone Marrow damage, also apply. 

There is a relatively wide variation in the duration and degree of post-irradiation edema in soft tissues. This edema seems to persist longer between muscle compartments than in fat or muscle itself. One study suggested that the edema resolved more slowly and that muscle atrophy was more severe in a neutron treated group as compared to a proton treated group. 

Re-irradiation is sometimes an option for local control, if the tumor recurs. Combined conservative surgery and re-irradiation provided superior local control to local re-excision alone and a functional outcome superior to amputation. Combined treatment with re-irradiation should be considered the primary salvage therapy for patients who fail combined therapy and who are suitable for conservative re-excision. 

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