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MCQ 7: Palliative Radiotherapy A 68-year-old woman with breast cancer and known bone metastases presents with severe pain in her left hip, uncontrolled by opioids. What is the most appropriate next step in management?A. Increase opioid doseB. Start bisphosphonatesC. Refer for palliative radiotherapyD. Perform nerve blockE. Start gabapentinAnswer: Refer for palliative radiotherapyExplanation: Palliative radiotherapy is highly effective for localized bone pain from metastases, especially when pain is uncontrolled by systemic analgesics. It can provide rapid pain relief and reduce analgesic requirements. While increasing opioids or adding adjuvants like gabapentin might help, radiotherapy addresses the underlying cause. Bisphosphonates are useful for preventing skeletal-related events but are less effective for acute pain management. Nerve blocks are invasive and usually considered after less invasive options.