Palliative Re-Irradiation of Bone Metastases – Case Report

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.