title: Retreatment with radiotherapy for symptomatic bone, brain or visceral metastases.
abstract: BACKGROUND
  The need for reirradiation in the metastatic disease appears when other modalities of treatment lose their efficacy. The aim of reirradiation in the metastatic disease is mainly palliative to control a particular symptom. However, this theoretical benefit must be confronted against the risk of an undesirable toxicity.
  
  
  METHODS
  Experience with reirradiation for symptomatic bone, brain or visceral metastases are reviewed. Twenty-two patients were found to have a second palliative radiotherapy on the same location. Locatión of metastases were visceral in 5 (23 %) patients, brain in 4 (18 %) patients, spine in 1 (4.5 %) patient and bone metastasis other than spine in 12 (54.5 %) patients. Median dose delivered in the first treatment was 30 Gy (range 20-30 Gy) and 20 Gy for the second treatment (range 6-32.4 Gy).
  
  
  RESULTS
  A good symptomatic response after first irradiation (complete response or disappearance of >50 % of symptoms) was reached in 21 (95.5 %) of the 22 patients analyzed. After second irradiation, 82 % (18 patients) achieved a good response, 3 (14 %) patients had a moderate response (relief of symptoms <50 %) whereas no response was observed in 1 (4 %) patient. Acute toxicity was limited to grade 1-2 proctitis in 2 and 3 patients after the first and second irradiation, respectively. No cases of late toxicity after the first or second irradiation were recorded.
  
  
  CONCLUSIONS
  A second treatment with palliative radiotherapy is feasible and well tolerated and offers the possibility of symptomatic relief in a high percentage of patients with symptomatic metastases.
authors.affiliation: Department of Radiation Oncology, University Hospital Ramón y Cajal, Cta. Colmenar Viejo km 9.100, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Hernanz
authors.forename: A
authors.initials: A
authors.lastname: Montero
authors.forename: E
authors.initials: E
authors.lastname: Fernandez-Lizarbe
authors.forename: A
authors.initials: A
authors.lastname: Polo
authors.forename: A
authors.initials: A
authors.lastname: Ramos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D001842:Bone and Bones / Q000473:pathology / Q000528:radiation effects; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D010166:Palliative Care; D011879:Radiotherapy Dosage; D012074:Remission Induction; D019233:Retreatment; D014781:Viscera / Q000473:pathology / Q000528:radiation effects