Intractable Pleural Effusion After Stereotactic Ablative Radiotherapy for Early-Stage Lung Cancer

Abstract

Stereotactic ablative radiotherapy (SABR) is an effective and attractive treatment option for patients who are poor surgical candidates. This case report describes a rare but serious complication of intractable pleural effusion after SABR for early-stage lung cancer. The patient was an 89-year-old woman with a medical history of early-stage breast cancer who was treated with partial resection and postoperative radiotherapy of 50 gray (Gy) in 25 fractions. SABR using 55 Gy in four fractions was conducted for lung lesions. The patient developed a pleural effusion that was refractory to conservative management and required multiple interventions, including repeated thoracentesis. This case report emphasizes the importance of monitoring and managing pleural effusion in patients with lung cancer receiving radiotherapy.

Keywords: adverse event; complication; early-stage lung cancer; pleural effusion; stereotactic ablative radiotherapy.

Figure 1. Chest computed tomography

Computed tomography obtained (A) before and (B) three months after stereotactic ablative radiotherapy for lung cancer in the left upper lobe. Blue arrows indicate the lesion.

Figure 2. Treatment plan of stereotactic ablative radiotherapy for the left upper lobe lesion

The treatment plan of stereotactic ablative radiotherapy for the left upper lobe lesion (A). The cumulative dose distribution of the previous two radiation treatment plans, consisting of breast irradiation 10 years prior and the current stereotactic ablative radiotherapy, was assessed by radiation therapy planning support software, SYNAPSE Radiotherapy provided by FUJIFILM Corporation (Tokyo, Japan).

Figure 3. Chest X-ray

Chest X-ray of the patient (A) before radiotherapy, (B) 18 months after radiotherapy, (C) 36 months after radiotherapy, and (D) 46 months after radiotherapy. Blue arrows indicate the pleural effusion.