Focal necrosis.

With more and more ablative radiation across various indications, we’re likely to see more and more toxicities unique to ablative doses. This case report includes slightly terrifying images of radiation myonecrosis one year following a very common stereotactic body radiation (SBRT) dose of 40 Gy in 5 fractions to a 2.4 cm C7 paravertebral renal cell carcinoma oligomet while on immune checkpoint and VEGF-inhibition. This 39 year old initially achieved a beautiful radiographic response prior to developing neck stiffness, pain, and eventually weakness. At 14 months, MRI demonstrated the afore-alluded-to lesion of central hypoenhancement with peripheral star-like enhancement, with relatively unremarkable imaging in the intervening months. Fortunately, her symptoms improved—though never completely resolved—with conservative measures alone. | Su, Appl Radiat Ocnol 2022