bims-rebome 2025-09-14 papers

Cancers (Basel). 2025 Sep 01. pii: 2878. [Epub ahead of print]17(17):

Management of Bone Health Considerations in Patients with Cancer.

Background: Older adults with cancer are surviving longer due to earlier detection and more effective treatments for advanced stages. This population is at an elevated risk of osteoporosis due to age-related changes in bone density as well as the impact of cancer and cancer treatments on the skeletal system. Main Body: Cancer treatments are associated with increased bone loss and fracture risk via a variety of mechanisms. International guidelines recommend screening for cancer treatment-induced bone loss and provide treatment algorithms for pharmacological agents for those on hormonal therapy. There is a paucity of guidelines on bone health protection for those receiving intermittent glucocorticoid and newer immunotherapy regimes. Results: All patients receiving cancer treatment should undergo an individualised fracture risk assessment to optimise their bone health with regular review and reassessment of their risk profile. Dedicated bone health guidelines in cancer populations should be expanded to consider the impact of newer treatment modalities. All patients should receive education around non-pharmacological management and undergo a shared decision-making approach where there are indications for bone-targeted agents. Conclusions: Bone health assessment is an integral part of comprehensive geriatric assessment for older people with cancer. Strategies to minimise bone density loss and reduce fracture risk are an important consideration for cancer survivorship programmes for the majority of people and require a standardised approach.

Keywords: ageing; bone health; cancer treatment-related bone loss; fracture risk; geriatric oncology; osteoporosis; survivorship

DOI: https://doi.org/10.3390/cancers17172878

J Clin Med. 2025 Sep 06. pii: 6297. [Epub ahead of print]14(17):

Epidemiology and Treatment of Metastatic Lesions Around the Elbow: A Systematic Review.

Andrea De Fazio, Giovan Giuseppe Mazzella, Guglielmo Miele, Maria Beatrice Bocchi, Omar El Ezzo, Giacomo Capece, Giulio Maccauro, Raffaele Vitiello.

Introduction: The elbow is a rare site for bone tumors, and for this reason, the literature provides little data on the epidemiology of metastatic lesions involving the distal humerus, proximal ulna, and radius. Before performing surgery of the metastatic bone, it is first necessary to consider both patients' and metastatic lesions' features in order to better choose the best possible treatment. This systematic review aims to collect data on elbow metastases, delineate primary tumors leading to such metastases, guide surgical treatment decisions, and evaluate reconstructive techniques and associated complications. Material and Methods: A systematic literature review was conducted in April 2024, searching the PubMed, MEDLINE, and Cochrane Library databases using specific search terms related to elbow metastases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) was followed. Eligible studies reported at least one patient with metastatic bone disease involving the elbow region and specified the undertaken treatment. For studies reporting multiple skeletal sites, only elbow-specific data were extracted. We excluded recurrences of primary elbow tumors. The methodological quality of included studies was assessed with the modified Coleman Methodology Score (mCMS). Results: In total, 28 articles (103 patients) were included. The studies were predominantly case reports (68%), with a mean mCMS of 31. Gender was reported for only 41 patients: 71% were male and 29% female. The mean age at diagnosis of elbow metastatic lesion was 55 years old. Renal cell carcinoma was the most common primary tumor (28%), followed by breast (9%) and lung cancer (6%). The distal humerus was the most frequently affected site (85%). A surgical approach was adopted in 90% of cases, whereas 10% of patients were managed conservatively. Forty-five patients underwent wide tumor resection followed by reconstructive surgery while forty-eight patients received a surgical treatment for either pathological fractures or impending fractures. Conclusions: When treating elbow metastasis, a thorough evaluation of the patient is crucial, considering the patient's functional status, pain management needs, and overall prognosis; all these features influence the treatment of choice. The selected treatment should aim to provide optimal functional outcomes and minimize complications. For patients with pathological or impending fractures, single or double plate fixation is typically the preferred approach. For patients with severe, symptomatic lesions unresponsive to conservative therapy, resection followed by the implantation of a modular prosthesis usually offers the best clinical and functional outcomes.

Keywords: bone resection; custom-made; elbow; elbow replacement; megaprosthesis; metastases; oncology; osteolytic lesion

DOI: https://doi.org/10.3390/jcm14176297

J Neurosurg Spine. 2025 Sep 12. 1-9

Oncological outcomes and safety after spinal reirradiation with stereotactic body radiotherapy.

Neil K Vuppala, Michael C LeCompte, Palak P Patel, Anjali J D'Amiano, Ali Bydon, Khaled Kebaish, Nicholas Theodore, Sang Hun Lee, Debraj Mukherjee, Binbin Wu, Lawrence Kleinberg, Daniel Lubelski, Kristin J Redmond.

OBJECTIVE: Spinal metastases pose a significant challenge in oncology, with incidence rates increasing alongside improved survival rates. Radiation therapy (RT) has played a crucial role in managing spinal disease progression and reducing associated neurological morbidity. However, management of spinal metastases for which prior RT failed is challenging, and there are limited data regarding the safety and efficacy of stereotactic body radiotherapy (SBRT) for reirradiation. The authors present the largest series to date of patients undergoing SBRT for reirradiation of spinal metastases.
METHODS: The medical records of patients treated with spine SBRT for reirradiation at a target that overlapped or abutted a previous radiation field between 2010 and 2021 were retrospectively reviewed. The cumulative constraint to the neural avoidance structures was a biologically effective dose with an α/β value of 3 of 75 Gy (above the conus) or 106 Gy (below the conus), accounting for 25% repair at 6 months and 50% repair at 1 year following the first course of RT. Radiographic local recurrence was defined according to Spine Response Assessment in Neuro-Oncology criteria as progressive disease in the treatment volume or at the margin of the treatment field on CT or MRI compared with imaging studies before SBRT. Cumulative incidence of local recurrence was reported with death as a competing event, and overall survival was estimated using Kaplan-Meier analysis. Toxicity grades were determined according to National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0.
RESULTS: A total of 224 vertebral segments from 89 lesions treated with SBRT reirradiation in 83 patients were included in this analysis. The median age at SBRT reirradiation was 63 years, with a median follow-up of 8.0 months. The most common primary cancer types were non-small cell lung cancer (18%), gastrointestinal cancer (16%), renal cell carcinoma (15%), and prostate cancer (15%). Lesions predominantly occurred in the thoracic spine (52%). The median time between initial RT and SBRT reirradiation was 15.4 months. Prior radiation techniques included 3D or 2D conformal RT (52%), SBRT (43%), and intensity-modulated radiotherapy (4%). Reirradiation SBRT prescription doses varied by fractionation, with a median planning target volume of 179.1 cm3. Immunotherapy use was associated with improved local control and, notably, no increase in toxicity. No cases of radiation myelopathy were observed.
CONCLUSIONS: SBRT reirradiation for progressive or recurrent spinal metastases appears to be a safe and effective treatment option, offering durable local control and pain relief with low toxicity. Future prospective and multi-institutional studies are warranted to validate these findings.

Keywords: local control; pain response; radiation toxicity; reirradiation; spinal metastases; stereotactic body radiotherapy; tumor

DOI: https://doi.org/10.3171/2025.4.SPINE241281