External radiation therapy (ERT) has been reported to be the elective treatment of symptomatic bone metastases. A nationwide survey on the use of ERT in elderly patients with bone metastases has been conducted by the Italian "Geriatric Radiation Oncology Group" with a three-fold aim: define the state of the art of ERT, evaluate the analgesic efficacy and identify the optimal dosage and schedule, if any. 347 patients aged 70 or over, treated in 29 different institutions for a period of six months were analyzed. Conclusive results were: a significant pain relief achieved shortly after ERT completion; an improvement in the quality of life; a decrease in the dose of analgesics and consequently, a reduction in treatment-related costs. Unfortunately the optimal treatment schedule remains unidentified; ERT was neither aggressive nor toxic in this series of elderly patients.