Management of Bone Metastases From Breast Cancer in Upper an
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Breast cancer is by far the most common cancer in women, and it has the highest incidence rates in western Europe. At breast cancer diagnosis, approximately 5-6% of women present with distant spread with bone, representing the most common site of metastatic lesions. More than half of the women, who present with metastatic breast cancer at the primary diagnosis, will develop bone metastases [4]. Breast cancer patients with bone metastases are at risk of skeletal-related events including bone pain which requires palliative radiotherapy. Radiation therapy is the most efficacious treatment for pain control in uncomplicated bone metastases.

Case Report
We report a clinical case of a 75-year-old woman, with a history of breast cancer who undergone surgery 7 years ago, presenting bone metastases in different areas. The lesion was found by a routine mammography 7 years ago and she was operated few months after the discovery. After 7 years of clinical silence from the diagnosis, the patient was submitted to a positron emission computed tomography (PET/CT) that showed multiple predominantly lytic lesions in several skeletal segments, especially to the left iliac wing and ipsilateral acetabulum, at the level of the right scapula and L4 and D10 vertebra. This result led to a palliative radiant treatment at the level of the L4 vertebrae with a total dose of 30 Gy in 10 fractions (3 Gy/fraction) provided with a 6 MeV flash technique. After 2 months from the treatment, a total body CT was performed and it confirmed the previous lesions seen in the PET/CT and showed new lesions to the vertebra from D1 to D5. A further CT few months later pointed out an unchanged condition but there was also a worsening of the lytic lesions in D3 and D4, confirmed by an MRI 1 month later....