Phrenic Nerve Palsy after Stereotactic Body Radiotherapy for Central Lung Cancer: A Case Report

Abstract

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  Radiation-induced phrenic nerve palsy is an uncommon complication of stereotactic body radiotherapy (SBRT) for central lung tumor. The resultant paralysis of hemidiaphragm can be symptomatic and compromise respiratory function.
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  The phrenic nerve can be delineated on planning computed tomography images using landmarks of the surrounding mediastinal structures. It should be considered a standard organ at-risk in thoracic SBRT where the planning target volume is in close proximity.
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  The dose-toxicity relationship of radiation-induced phrenic nerve palsy remains unclear. Nevertheless, the risk of palsy may be reduced by careful plan optimization, hotspot control within the planning target volume, respiratory motion management, and robust treatment verification.