Bone metastasis is a severe complication of malignant tumors. Management of multiple bone metastases remains difficult and prognosis is generally unfavorable, radiotherapy being often the therapeutic option. The main goals of the palliative irradiation of bone metastases are the reduction of pain intensity and the decreasing the analgesic dose used. Overall survival of patients with oligometastatic disease for hormone dependent cancers like breast and prostate may exceed three years and for these groups of patients the reduction of the associated tardive toxicity after irradiation is essential for preserving the quality of life. We present the case of a patient diagnosed in March 2011 with prostate cancer, multiple bone metastases in November 2012. In December 2012, palliative radiotherapy was administrated in a total dose of 21Gy/fractions, weekly in the lumbosacral region. Seven years after the first presented an increase in pain intensity in the left ischio-pubian branch and pubic symphysis and the bone scintigraphy reveal the progression of the metastatic disease. Palliative re-irradiation was administrated in total dose of 20Gy/5fractions in painful region. Re-irradiation for bone metastasis remains a therapeutic option with the potential to reduce the pain. Image guided radiotherapy can reduce the risk of late toxicity, especially for long-term survivors.

Diabetes mellitus is often associated with a risk of developing some types of cancer. The association between head and neck cancers and diabetes as well as prognosis and treatment tolerance remains a controversy. Acute toxicities associated with treatment may be amplifi ed by the presence of comorbidities, including hypertension, diabetes and collagen diseases. Another factor implicated in the treatment tolerance is also the limitation by the presence of hyperglycemia of the corticosteroids dose used for the control of pain and edema associated with chemo-irradiation and for the treatment of thrombocytopenia. The purpose of the study was to evaluate the involvement of diabetes mellitus in the toxicities associated with chemo-radiotherapy treatment in multimodal treated patients for advanced local head and neck cancers. For patients with locally advanced non-metastatic head and neck treated with multimodal (chemo-radiotherapy) acute toxicities (radio-dermitis, radio-mucositis, dysphagia) was analyzed comparatively in patients who associate or not cancer with diabetes. It was also compared if the diagnostic of diabetes influenced the intensity of chemotherapy. Identifying the predictive value of diabetes mellitus for the severity of toxicities in multimodal curative treatment for head and neck cancers can lead to limitation of radiation dose to some radiosensitive anatomical structures in the context of the modern IMRT and VMAT irradiation techniques implementation in clinical practice.