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Editor’s note: Meta-analyses of clinical trials have shown that adjuvant radiotherapy reduces the risk of local breast cancer recurrence and improves survival. A survival advantage has also been reported in post-mastectomy trials in which radiotherapy included regional irradiation to lymph node areas – the axilla, supraclavicular area, and the internal mammary chain. However, regional irradiation increases the volumes of lung and heart being irradiated and, consequently, the risk of pulmonary and cardiotoxicity. Another potential toxicity, investigated in the present study, is ischemic stroke secondary to carotid stenosis.