Would you recommend re-irradiation to the pelvis for palliation of bone metastases in a patient who previously had prostate brachytherapy?

Great question. So a patient with prior brachy only for his prostate cancer needs palliation for bone met in the pelvic region.

I guess my first question would be what type of implant HDR/LDR and at what time did he received the implant? Dose of implant too!

What is his clinical state: Age / KPS / cancer extent or burden / life expectancy / location of the met..... in relationship to the implant / is the met accessible to electrons or photons w/ IMRT or SBRT?

If the patient has say less than a 30 day life expectancy, I have no problem with delivering a ultra-hypofractionated dose of palliative RT 400cGy x 5 or 800cGy 1.

If he has a longer LE and good KPS, I would probably go to 300cGy x10 or 400cGy x 5 dosing schemes depending on its closen...