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Post-op RT Pathological Fracture — SCE Medical Oncology MCQ

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HardOncological EmergenciesPost-op RT Pathological FractureSCE Medical Oncology

Three weeks after fixation of a painful metastatic proximal-femoral fracture, the wound has healed, pain persists and predicted survival is about 9 months. Which radiotherapy plan is supported by Royal College of Radiologists guidance?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Treat the fixed site with 8 Gy once or 20 Gy in 5 fractions, guided by prognosis and rehabilitation goals

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · E = shown as D · B = shown as E

B is correct. RCR guidance lists 8 Gy in one fraction or 20 Gy in five fractions after fixation of bone metastases; treatment choice considers persistent pain, rehabilitation goals, performance status and predicted survival. A omits local tumour control and palliation in a patient who remains symptomatic. C turns one acceptable multifraction approach into a universal longer course and unnecessarily irradiates the whole bone. D is not a substitute for local postoperative treatment of a fixed lesion. E disregards wound recovery and invents routine repeat irradiation. Field design should cover relevant metastatic and operative disease while respecting normal tissue.

Reference: Royal College of Radiologists radiotherapy dose-fractionation guidance: https://www.rcr.ac.uk/media/fezluddf/rcr-publications_radiotherapy-dose-fractionation-third-edition_march-2019.pdf