Radiation-induced myelopathy after hypofractionated radiotherapy in women with spinal metastases from breast cancer — a case report

Hypofractionated radiotherapy, with a single dose of 8 Gy or 20 Gy given in 4–5 fractions, remains a standard treatment of bone metastasis, including spine lesions. Hypofractionated radiotherapy is also used during re-irradiation. These schedules are associated with an increased risk of severe complications, and their differentiation from local tumour progression can be difficult. We describe a 55-year-old female with breast cancer, who underwent palliative radiotherapy with a dose of 20 Gy in four fractions to the Th6–Th10 spine levels. After four months the patient was referred for re-irradiation due to progression of neurological symptoms. MRI examination suggested local tumour progression. Due to rapid deterioration she did not receive re-irradiation, and died due to systemic fungal infection. Autopsy revealed extensive radiation myelopathy in previously irradiated thoracic spine, without the presence of cancer at the site