bims-rebome Biomed News
on Rehabilitation of bone metastases
Issue of 2025–07–13
seven papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata
  1. The Influence of Social Determinants on Clinical Presentation in Patients Surgically Treated for Metastatic Spinal Disease.
  2. Treatment Approach for Bilsky Grade 2 Metastatic Epidural Spinal Cord Compression Based on Radiation Therapy Failure Risk.
  3. Neuro-Modulation for Intractable Pain From Bone Metastasis Using Real-Time Adaptive Motion Management on a Robotic Radiation Therapy Platform: A Case Report and Review of the Literature.
  4. Interpretable machine learning models for survival prediction in prostate cancer bone metastases.
  5. EHA-EMN Evidence-Based Guidelines for diagnosis, treatment and follow-up of patients with multiple myeloma.
  6. Assessment Scores for Patients with Central Neurological Conditions in Rehabilitation: A Systematic Review.
  7. Anthropometrics, cancer risks, and survival outcomes in adult patients with glioma - a systematic review and meta-analysis.
  1. Spine J. 2025 Jul 08. pii: S1529-9430(25)00327-4. [Epub ahead of print]
    The Influence of Social Determinants on Clinical Presentation in Patients Surgically Treated for Metastatic Spinal Disease.
    Bram T van Munster, Jantijn J G J Amelink, Olivier Q Groot, Tom M de Groot, Jorrit-Jan Verlaan, Daniel G Tobert.
       BACKGROUND: Spinal metastases can result in compression of the spinal cord with neurological symptoms in an acute setting. Surgical intervention is often necessary to mitigate the risk of irreversible neurological impairment. Therefore, an enhanced risk assessment for acute presentation in patients with spinal metastases could be highly valuable. Social Determinants of Health (SDOH) are non-medical variables that influence health outcomes. The impact of SDOH on patient presentation prior to surgery in patients with spinal metastases remains unexplored.
    PURPOSE: This study aimed to investigate (1) whether patients with unfavorable SDOH present more often with acute neurological symptoms in the setting of spinal metastases undergoing surgery and (2) whether patients with unfavorable SDOH present more often with acute neurological symptoms as the first symptom of spinal metastases.
    STUDY DESIGN: Retrospective cohort study PATIENTS SAMPLE: Patients aged 18 years or older, who underwent surgical treatment for spinal metastases at two affiliated tertiary centers in Boston between January 1st, 2017, and December 31st, 2022.
    OUTCOME MEASURES: The primary outcome was presentation with acute neurological symptoms of spinal metastases within 14 days prior surgery. We defined acute neurological symptoms using the American Spinal Injury Association (ASIA) impairment scale to determine if a patient exhibited any neurological deficit (score of A, B, C, or D).
    METHODS: We identified in total 555 patients: 162 (29%) presented with acute neurological symptoms ≤14 days before surgery, while 393 (71%) did not present with acute neurological symptoms before surgery. The SDOH were evaluated using a multivariate regression for presentation with preoperative acute neurological symptoms.
    RESULTS: Two SDOHs were associated with an increased risk to present with acute neurological symptoms prior to surgery: patients without a partner, who were divorced (OR, 2.50 [95% CI, 1.17 to 5.35]; p=0.018), and patients who were not employed (OR=2.46 [95%CI=1.11-5.43]; p=0.025). Additionally, patients were also more likely to present with acute neurological symptoms prior to surgery with: a higher ECOG score (OR=4.82 [95%CI=2.78-8.51]; p<0.001), a higher Bilsky score (OR=4.58 [95%CI=2.33-9.80]; p<0.001), a greater number of spinal metastases (OR=2.44 [95%CI=1.41-4.35]; p=0.002), and the absence of visceral metastases (OR=0.58 [95%CI=0.37-0.90]; p=0.017). No factors, including SDOHs, were observed that influenced acute neurological symptoms as the initial symptom in spinal metastases.
    CONCLUSION: In patients with spinal metastases who are eligible for surgical treatment, unfavorable SDOHs are associated with acute neurological presentation. Identifying unfavorable SDOHs may support risk stratification efforts by highlighting patients who appear more likely to present with acute neurological symptoms in a surgical cohort.
    Keywords:  clinical presentation; metastases; social determinants of health; spinal metastatic disease; spine; surgery
    DOI:  https://doi.org/10.1016/j.spinee.2025.07.001
  2. Global Spine J. 2025 Jul 10. 21925682251359292
    Treatment Approach for Bilsky Grade 2 Metastatic Epidural Spinal Cord Compression Based on Radiation Therapy Failure Risk.
    Sehan Park, Dong-Ho Lee, Chang Ju Hwang, Gumin Jeong, Ji Uk Choi, Hyuk-Joon Sohn, San Kim, Yeon Joo Kim, Jae Hwan Cho.
      Study designRetrospective cohort study.ObjectivesThis study evaluated the outcomes of radiation therapy (RT) as the initial treatment for Bilsky grade 2 metastatic epidural spinal cord compression (MESCC) and identified the risk factors associated with RT failure.MethodsThis retrospective cohort study enrolled 151 patients diagnosed with Bilsky grade 2 MESCC. Patients were divided into 2 groups, viz. those who initially underwent RT (n = 127) and those treated with surgery at presentation (n = 24). The patient demographics, treatment outcomes, and risk factors for RT failure were analyzed. The Spinal Instability Neoplastic Score (SINS) and clinical outcomes such as ambulatory status and neurological function were compared. Logistic regression was performed to identify factors predictive of RT failure.ResultsRT was successful in 85.8% (109/127) of patients, and only 14.2% (18/127) required surgery due to symptom progression. The SINS were significantly higher in the RT-failure group (9.6 ± 3.2) than in the RT-success group (7.4 ± 2.8, P = 0.003). SINS scores >8 were associated with a higher risk of RT failure. Patients the surgery group were younger and presented more frequently with neurological deficits. No significant differences in final ambulatory status or survival were observed between the RT-success and RT-failure subgroups.ConclusionsRT can be a viable initial treatment option for Bilsky grade 2 MESCC in the absence of neurological deficits or severe mechanical pain. However, patients with greater spinal instability (SINS >8) face a higher risk of RT failure and may benefit from surgical intervention at diagnosis.
    Keywords:  Bilsky grade 2; metastatic epidural spinal cord compression; radiation therapy; spinal instability; spinal metastases; surgery
    DOI:  https://doi.org/10.1177/21925682251359292
  3. Cureus. 2025 Jun;17(6): e85421
    Neuro-Modulation for Intractable Pain From Bone Metastasis Using Real-Time Adaptive Motion Management on a Robotic Radiation Therapy Platform: A Case Report and Review of the Literature.
    Seblewongel Enyew, Binbin Wu, Christopher Jackson, Raj Mukherjee, Jordina Rincon Torroella, Daniel Lubelski, Lawrence R Kleinberg, Kristin J Redmond.
      Radiosurgical hypophysectomy has emerged as a promising noninvasive approach for management of intractable cancer pain, particularly in patients with bone metastases, offering a safer alternative to traditional surgical hypophysectomy. Here, we present the case of a premenopausal woman with metastatic breast cancer who developed severe, refractory pain despite conventional pain management. To alleviate worsening pain, the patient underwent radiosurgical hypophysectomy targeting approximately 8 mm of the inferior pituitary stalk and at least 50% of the pituitary gland, using a single 75.0 Gy fraction prescribed to the 50% isodose line. Robotic real-time adaptive radiotherapy was utilized for precision and to avoid unnecessary damage to surrounding critical structures. Following treatment, the patient experienced immediate and significant pain relief. Specifically, pain scores measured using the visual analogue pain score showed a decrease in pain level from 8/10 pre-treatment to 4/10 by day 10 post-treatment. The baseline pain remained around 4-5/10 over time with occasional spikes to 7/10. No meaningful adverse effects were reported, supporting the safety aspect of this approach. These findings are consistent with existing studies that reported immediate pain relief after radiosurgical hypophysectomy, although longer-term outcomes remain variable. This case highlights the potential of radiosurgical hypophysectomy as a valuable option for patients with severe cancer pain, underscoring the need for further clinical studies to validate its effectiveness and explain the underlying mechanisms as well as pain outcome in the long term.
    Keywords:  bone metastases; hypophysectomy; neuromodulation; pain; stereotactic radiosurgery
    DOI:  https://doi.org/10.7759/cureus.85421
  4. Sci Rep. 2025 Jul 06. 15(1): 24150
    Interpretable machine learning models for survival prediction in prostate cancer bone metastases.
    Hua Zhang, Bingtian Dong, Jialin Han, Lewen Huang.
      Prostate cancer bone metastasis (PCBM) is a highly lethal condition with limited survival. Accurate survival prediction is essential for managing these typically incurable patients. However, existing clinical models lack precision. This study seeks to establish machine learning models to improve survival predictions for PCBM patients. We extracted data for PCBM patients from the SEER database spanning 2010 to 2019. Prognostic features were identified through univariate and multivariate Cox regression analyses. To predict survival outcomes, we developed and validated XGBoost models with five-fold cross-validation. Model performance was assessed based on the area under the receiver operating characteristic curve (AUC) and overall accuracy. Feature importance was assessed using SHAP (SHapley Additive exPlanations) values, while decision curve analysis was conducted to determine the clinical applicability of the models. Additionally, Kaplan-Meier (K-M) analysis was employed to examine the impact of surgery, radiotherapy, and chemotherapy on the survival of PCBM patients. The XGBoost models achieved robust performance in predicting survival for PCBM patients, with AUC values of 0.76, 0.83, and 0.91 for 1-year, 3-year, and 5-year survival predictions, respectively, in the test set. Key prognostic factors included T stage, grade, age, PSA, and Gleason score. Single patients exhibited a significantly higher mortality risk than their married counterparts (HR = 1.23, 95% CI 1.19-1.27, p < 0.001). Conversely, a median household income exceeding $75,000 was associated with a notably reduced mortality risk (HR = 0.87, 95% CI 0.85-0.90, p < 0.001). Univariate Cox analysis showed that surgery, chemotherapy, and radiotherapy were all significantly associated with improved survival. However, multivariate Cox regression analysis indicated that only chemotherapy (HR = 0.85, 95% CI 0.81-0.89, p < 0.001) and radiotherapy (HR = 0.96, 95% CI 0.93-0.99, p = 0.032) remained significant, while surgery (HR = 0.98, 95% CI 0.93-1.03, p = 0.387) did not. SHAP summary and force plots were utilized to analyze the XGBoost model both on a global and local scale. Subsequently, a web-based tool was created to streamline the integration of this predictive model into clinical settings. Our study examined the clinical features of patients with PCBM and developed six machine learning models for prognosis, with the XGBoost model demonstrating the highest performance. The model's high accuracy and interpretability provide valuable support for developing personalized treatment plans for PCBM patients.
    Keywords:  Bone metastasis; Prostate cancer; SEER; Survival prediction; XGBoost
    DOI:  https://doi.org/10.1038/s41598-025-09691-8
  5. Nat Rev Clin Oncol. 2025 Jul 07.
    EHA-EMN Evidence-Based Guidelines for diagnosis, treatment and follow-up of patients with multiple myeloma.
    Meletios A Dimopoulos, Evangelos Terpos, Mario Boccadoro, Philippe Moreau, María-Victoria Mateos, Sonja Zweegman, Gordon Cook, Monika Engelhardt, Michel Delforge, Roman Hajek, Fredrik Schjesvold, Francesca Gay, Salomon Manier, Katja C Weisel, Martin Kaiser, Niels W C J van de Donk, Elena Zamagni, Paula Rodriguez-Otero, Aurore Perrot, Christoph Driessen, Jelena Bila, Edward Laane, Dominik Dytfeld, Cyrille Touzeau, Meral Beksac, Marc S Raab, Michele Cavo, Mohamad Mohty, Andrew Spencer, Heinz Ludwig, Hermann Einsele, Jesus San-Miguel, Pieter Sonneveld.
      Since the publication in 2021 of the European Hematology Association (EHA) Clinical Practice Guidelines for the treatment of patients with smouldering multiple myeloma (SMM) and multiple myeloma (MM), developed in collaboration with the European Society for Medical Oncology, a novel international staging system (R2-ISS) has been developed, several prognostic factors are entering clinical practice (such as minimal residual disease, circulating plasma cells and monoclonal protein assessed by mass spectrometry) and, at the time of writing, 14 novel regimens have been approved by the EMA and/or the FDA for the treatment of patients with MM. A multidisciplinary group of experts from the EHA and European Myeloma Network, based in various institutions mostly located in Europe, have updated the previous guidelines and produced algorithms for everyday clinical practice that incorporate levels of evidence and grades of recommendation based on the aforementioned new data. In these Evidence-Based Guidelines, we provide key treatment recommendations for both patients with newly diagnosed MM and those with relapsed and/or refractory MM, including guidance for the use of established drugs as well as contemporary immunotherapies. Novel approaches for the management of patients with SMM focus on those who might require early intervention. Finally, we provide recommendations for myeloma-related complications and adverse events, such as bone disease, renal impairment and infections, as well as for those associated with T cell-mobilizing therapies, such as cytokine-release syndrome and immune effector cell-associated neurotoxicity syndrome.
    DOI:  https://doi.org/10.1038/s41571-025-01041-x
  6. IEEE Int Conf Rehabil Robot. 2025 May;2025 675-680
    Assessment Scores for Patients with Central Neurological Conditions in Rehabilitation: A Systematic Review.
    Silvia Campagnini, Kaan Borekci, Kyle Embry, Arun Jayaraman.
      In rehabilitation, evidence-based practice relies on evaluating patients' standardized outcomes to manage care plans and resources; however, the selection of tools to use is globally inconsistent. Alternatively, emerging technologies can measure high-resolution biomarkers, but their implementation remains a challenge. Given the amount of measures, interest in new scoring systems of patient health synthesizing multisource data is rising. Emerging research in rehabilitation lacks standardized guidelines and psychometric validation of these scores. Hence, this review systematically examines the methods used for developing and validating patient assessment scores in rehabilitation. A systematic search included studies on the development and validation of scores to assess adult patients with central neurological disorders in rehabilitation. Nineteen studies were synthesized. In the score development, simpler methods and input data were more common (11 studies used statistics, 12 clinical data). In the validation, the heterogeneity in reference standards and tests in scores' psychometric analysis highlights the need for evidence and standardized processes in this field. Clinically relevant information is crucial for implementable scores able to guide clinical decision-making and care strategies. Future studies should adopt exploratory approaches, analyzing various input data, methods, and psychometric properties' impact on the score capability to assess patient health.
    DOI:  https://doi.org/10.1109/ICORR66766.2025.11062944
  7. Acta Neurochir (Wien). 2025 Jul 10. 167(1): 188
    Anthropometrics, cancer risks, and survival outcomes in adult patients with glioma - a systematic review and meta-analysis.
    Jaehyun Ahn, Joonseok Kim, Christopher Shin, Stephen Ahn.
       PURPOSE: The association between anthropometric measures including BMI, height and cancer has been widely discussed. However, the role of these in the development and prognosis of glioma remains controversial. We aimed to study these relationships.
    METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Papers reporting relationship between anthropometric measures and the risk of glioma, both incidence and survival, were considered relevant. Those published until January 31, 2024, were selected from PubMed, EMBASE, and the Cochrane Library. Studies were evaluated according to the modified Newcastle Ottawa Scale. Hazard ratios, relative risks, and 95% confidence intervals were pooled and synthesized using a random effects model.
    RESULTS: Among 940 screened articles, 23 were selected. Taller height was significantly associated with an increased risk of both glioma (HR per 10 cm, 1.19; CI, 1.16 to 1.23) and glioblastoma (HR per 10 cm, 1.25; CI, 1.18 to 1.31). Higher BMI was positively correlated with an increased risk of glioma, both in categorical (RR, 1.08; CI, 1.03 to 1.12) and continuous measures (HR per 5 kg/m2, 1.01; CI, 1.00 to 1.03). Glioblastoma demonstrated a higher incidence risk (HR per 5 kg/m2, 1.02; 95% CI 1.00 to 1.05) and better survival outcomes (HR 0.75; 95% CI 0.59 to 0.96) with increasing BMI.
    CONCLUSION: This study provides critical insights into the relationship between glioma and anthropometric measures. Glioma and glioblastoma were associated with these measures in terms of both incidence and survival. Further research is necessary to uncover the mechanisms and develop preventative or therapeutic strategies.
    Keywords:  Anthropometric measurements; Glioma; Prognostic factor; Risk factors; Survival
    DOI:  https://doi.org/10.1007/s00701-025-06579-4
This page is being maintained by Thomas Krichel. It was last updated on 2025‒07‒13 at 2:55.