Abstract

Stereotactic body radiation therapy (SBRT) is an increasingly common treatment for lung and liver malignancies. Chest wall toxicity following SBRT for peripheral tumors has been reported and there are published dose constraint guidelines to minimize the risk for rib fracture, chest wall necrosis, and cutaneous ulceration.1-4 There are no documented reports of diaphragm injury after SBRT and no defined tolerance dose. We describe in this report the clinical course of a patient who developed severe back pain following liver SBRT and was found to have focal necrosis, fibrosis, and atrophy of the diaphragm in the high-dose region on autopsy.

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