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.

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Pleural effusion after thoracic radiation therapy is an important adverse event affecting the patient's quality of life. A 58-year-old woman was referred to our hospital with the complaint of exertional dyspnea for several months. Chest radiography revealed left pleural effusion, most likely related to radiotherapy to mediastinal and left cervical lymph nodes in the treatment of localized Hodgkin lymphoma 25 years ago. She was followed for the next eight years and experienced a slow exacerbation of pleural effusion. Here, we report a case of extremely late-onset pleural effusion after thoracic radiotherapy.