A Case of Palliative Radiotherapy for Headache Due to Postoperative Skull Metastasis of Pancreatic Cancer

ABSTRACT

Introduction: Pancreatic cancer often recurs as local recurrence or peritoneal dissemination, causing severe abdominal and back pain. We report a case of postoperative skull metastasis of pancreatic cancer that caused headache and was treated effectively with radiotherapy. Case: A 67-year-old woman underwent surgery for pancreatic cancer. She had epigastric pain due to local recurrence and peritoneal dissemination, which was controlled with loxoprofen and fentanyl transdermal patch. She had right-sided headache, which gradually increased in intensity, but lacked intracranial hypertension and focal neurological symptoms. Acetaminophen and Goreisan did not provide adequate pain relief. Although CT showed no brain or bone metastasis, MRI showed metastasis in the right frontal bone. Palliative radiotherapy was administered. Subsequently, headache decreased from 7–8/10 to 2–3/10 on the Numerical Rating Scale. Conclusion: Skull metastases in cancer patients may be diagnosed using MRI, even when they remain undetectable by CT.