Abstract
We report the case of a woman who presented with breast cancer metastases to the femur causing pathologic fracture of the femoral neck requiring surgery. She received adjuvant radiotherapy to the femur at that time that did not include the surgical scar tract. Almost four years after her surgery she presented with biopsy proven skin recurrence of breast cancer on the skin overlying her incision from her femoral surgery.Further imaging confirmed significant soft-tissue disease involving the underlying surgical scar tract. This case provides important information about the possibility of surgical scar recurrence after surgery for bone metastases which could indicate the need to include the area of the surgical scar tract and the entire prosthetic material in the post-operative radiotherapy volume.
Highlights
Bone metastases are present in up to two-thirds of patients with metastatic cancer [1]
One lingering question regarding target volumes for palliative radiotherapy is whether the operative bed and surgical scar should be included in radiotherapy volumes in addition to areas of bone that were involved preoperatively
We present the interesting case of an 81-year-old woman who presented with relapse of breast cancer in her femur both in her surgical scar and at the margin of her previous radiotherapy field
Summary
Bone metastases are present in up to two-thirds of patients with metastatic cancer [1]. She was treated with palliative radiotherapy of a single fraction of 8 Gray (Gy) to this area because of poor performance status. The radiation plan was generated with a source skin distance (SSD) of 110 cm with parallel-opposed 6 Megavolt (MV) photon fields to allow adequate coverage (Figure 5)
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