bims-rebome Biomed News
on Rehabilitation of bone metastases
Issue of 2025–10–19
seven papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata
  1. Advances in Metastatic Disease Spinal Oncology: Novel Technology Without Forgetting the Fundamentals of Surgical Treatment.
  2. Efficacy of Bone-Modifying Agents in Preventing Vertebral Complications of Multiple Myeloma: A Systematic Review and Meta-Analysis.
  3. Large Language Model (LLM)-Predicted and LLM-Assisted Calculation of the Spinal Instability Neoplastic Score (SINS) Improves Clinician Accuracy and Efficiency.
  4. Movement-Based Interventions in Patients Affected by Bone Metastases: Impact on Physical Function and Functional Autonomy-A Systematic Review.
  5. Changes in Performance Status and Predictive Factors for Poor Improvement Following Surgery for Spinal Metastasis: A Nationwide Multicenter Prospective Cohort Study.
  6. Radiological response assessment after stereotactic body radiotherapy for spine metastases using magnetic resonance imaging: a systematic review.
  7. Cost-Effectiveness of Denosumab for Treating Bone Metastases from Solid Tumors: A Systematic Review (2017-2023).
  1. Neurospine. 2025 Sep;22(3): 829-845
    Advances in Metastatic Disease Spinal Oncology: Novel Technology Without Forgetting the Fundamentals of Surgical Treatment.
    Harsh Jain, Ranbir Ahluwalia, Ilya Laufer, Scott L Zuckerman.
      Metastatic spine disease represents a growing therapeutic challenge that demands a balance between incorporating emerging technologies while respecting the fundamental principles during clinical decision-making. Advances in adjuvant therapies, including stereotactic body radiotherapy (SBRT) and chemotherapy, have significantly improved long-term patient survival. Surgical decision-making should be guided by well-established frameworks such as the NOMS (neurologic, oncologic, mechanical, systemic) criteria, the ESCC (epidural spinal cord compression) scale, and the SINS (spinal instability neoplastic score), ensuring a structured and evidence-based approach to treatment. The integration of minimally invasive techniques, including percutaneous instrumentation, ablation techniques, and biportal endoscopic approaches, has reduced surgical morbidity and facilitated faster recovery. Additionally, carbon fiber implants are revolutionizing spinal stabilization by allowing better postoperative visualization of any local recurrence and easier radiation planning. SBRT has emerged as a critical modality, offering precise, high-dose radiation with minimal toxicity to the spinal cord, improving local tumor control and patient outcomes. A multidisciplinary approach remains paramount, requiring collaboration between spine surgeons, radiation oncologists, and medical oncologists. In this narrative review, we aim to provide a comprehensive overview of the current state of metastatic spine tumor management, focusing on: (1) fundamentals of metastatic spine care, (2) minimally invasive surgical techniques, (3) the use of carbon fiber screws, (4) SBRT, and (5) ways to maximize patient safety.
    Keywords:  Carbon fiber implants; Metastatic spine disease; Minimally invasive spine surgery; NOMS framework; Spinal Instability Neoplastic Score; Stereotactic body radiotherapy
    DOI:  https://doi.org/10.14245/ns.2550476.238
  2. Spine J. 2025 Oct 14. pii: S1529-9430(25)00850-2. [Epub ahead of print]
    Efficacy of Bone-Modifying Agents in Preventing Vertebral Complications of Multiple Myeloma: A Systematic Review and Meta-Analysis.
    Zsombor T Gal, Ethan A Wetzel, Brian V Nahed, Philip J Saylor, Joshua A Hirsch, Ariel E Marciscano, Noopur S Raje, Daniel G Tobert, Andrew J Yee, Ganesh M Shankar.
       BACKGROUND CONTEXT: Bone disease in patients with multiple myeloma (MM) is associated with vertebral complications, which include vertebral fractures and spinal cord compression (SCC). Bone-modifying agents (BMAs), namely bisphosphonates and denosumab, are recommended to reduce skeletal-related events in MM, yet their efficacy in preventing vertebral fractures and SCC remains unclear.
    PURPOSE: To determine the efficacy of BMAs in reducing the risk for vertebral fractures and SCC in adults with MM.
    STUDY DESIGN: Systematic review and meta-analysis following PRISMA guidelines.
    METHODS: A systematic search of PubMed, Embase, and Web of Science databases was performed on July 11, 2024. Risk of bias, reporting bias, and evidence certainty were evaluated using the RoB 2 tool, funnel plot and Egger's test, and the GRADE approach, respectively. Relevant data were extracted and pooled for pairwise and network meta-analysis.
    RESULTS: After removing duplicates, 1354 studies were screened, 108 full-text studies were reviewed for inclusion, and 11 randomized trials were included in the analysis. Compared to no treatment or placebo, lower-potency bisphosphonates were associated with a reduction in the risk for vertebral fractures, with a pooled RR of 0.72 (95% CI: 0.61 to 0.85, p = 0.0001), suggesting a 28% reduction in risk. Zoledronate was the most efficacious bisphosphonate in the network meta-analysis, with a 64% reduction in vertebral fracture risk compared to no treatment or placebo (RR = 0.36, 95% CI: 0.16 to 0.77, p = 0.009). None of the included studies reported the clinical significance of these vertebral complications, and no studies that investigated denosumab met inclusion criteria. Meta-analysis for the SCC outcome was inconclusive due to limited evidence.
    CONCLUSIONS: The body of literature indicates that bisphosphonates, particularly zoledronate, significantly reduce the risk for vertebral fractures in patients with MM, at least in trial conditions. Additional evidence is necessary to evaluate the real-world clinical impact of these findings, clarify the effects on risk for SCC, and investigate denosumab.
    Keywords:  bisphosphonates; bone-modifying agents; multiple myeloma; spinal cord compression; vertebral compression fractures; vertebral fractures
    DOI:  https://doi.org/10.1016/j.spinee.2025.10.018
  3. Cancers (Basel). 2025 Sep 30. pii: 3198. [Epub ahead of print]17(19):
    Large Language Model (LLM)-Predicted and LLM-Assisted Calculation of the Spinal Instability Neoplastic Score (SINS) Improves Clinician Accuracy and Efficiency.
    Matthew Ding Zhou Chan, Calvin Kai En Tjio, Tammy Li Yi Chan, Yi Liang Tan, Alynna Xu Ying Chua, Sammy Khin Yee Loh, Gabriel Zi Hui Leow, Ming Ying Gan, Xinyi Lim, Amanda Kexin Choo, Yu Liu, Jonathan Wen Po Tan, Ee Chin Teo, Qai Ven Yap, Ting Yonghan, Andrew Makmur, Naresh Kumar, Jiong Hao Tan, James Thomas Patrick Decourcy Hallinan.
      Background: The Spinal Instability Neoplastic Score (SINS) guides treatment for patients with spinal tumors, but issues arise with complexity, interobserver variability, and time demands. Large language models (LLMs) may help overcome these limitations. Objectives: This study evaluates the accuracy and efficiency of a privacy-preserving LLM (PP-LLM) for SINS calculation, with and without clinician involvement, to assess its feasibility as a clinical decision-support tool. Methods: This retrospective observational study was granted a Domain-Specific Review Board waiver owing to minimal risk. Patients from 2020 to 2022 were included. A PP-LLM was employed to maintain secure handling of patient data. A consensus SINS reference standard was established by musculoskeletal radiologists and an orthopedic surgeon. Eight orthopedic and oncology trainees were divided into two groups to calculate SINS, with and without PP-LLM assistance. LLM-predicted scores were also generated independently of any human input. Results: The main outcomes were agreement with the reference standard (measured by intraclass correlation coefficients [ICCs]) and time required for SINS calculation. The LLM-assisted method achieved excellent agreement (ICC = 0.993, 95%CI = 0.991-0.994), closely followed by the LLM-predicted approach (ICC = 0.990, 95%CI = 0.984-0.993). Clinicians working without LLM support showed a significantly lower ICC compared to both LLM methods (0.968, 95%CI = 0.960-0.975) (both p < 0.001). The LLM alone produced scores in approximately 5 s, while the median scoring time for LLM-assisted clinicians was 60.0 s (IQR = 46.0-80.0), notably shorter than the 83.0 s (IQR = 58.0-124.0) required without LLM assistance. Conclusions: An LLM-based approach, whether used autonomously or in conjunction with clinical expertise, enhances both accuracy and efficiency in SINS calculation. Adopting this technology may streamline oncologic workflows and facilitate more timely interventions for patients with spinal metastases.
    Keywords:  autonomous artificial intelligence; large language model; spinal instability neoplastic score
    DOI:  https://doi.org/10.3390/cancers17193198
  4. Cancers (Basel). 2025 Oct 09. pii: 3266. [Epub ahead of print]17(19):
    Movement-Based Interventions in Patients Affected by Bone Metastases: Impact on Physical Function and Functional Autonomy-A Systematic Review.
    Giorgia Petrucci, Agnese Broccolo, Anna Marchetti, Chiara Monterosso, Giuseppe Casale, Chiara Timarco, Tea Zeppola, Silvia Dsoke, Elena Sandri, Michela Piredda, Giuseppe Francesco Papalia, Maria Grazia De Marinis.
      Background: Bone metastases are a common complication in patients with advanced cancer. These patients often experience a decline in physical function and autonomy, particularly in the ability to perform Activities of Daily Living, and structured movement-based interventions may represent an important supportive strategy. The aim of this study is to describe the available evidence regarding the impact of physical activity and exercise interventions on functional status and ADL performance in patients with bone metastases. Methods: A systematic literature review was conducted in PubMed, Scopus, Embase, Web of Science, and CINAHL database up to March 2025 and reported according to PRISMA guidelines. Eligible studies included adults (≥18 years) with confirmed bone metastases who underwent physical activity interventions designed to enhance functional status and ADLs. Studies' methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools, selected according to study design. Results: Eleven studies were included: four randomized controlled trials, four quasi-experimental studies, one randomized feasibility trial, one cross-sectional observational study, and one case report. Despite heterogeneity in intervention type, duration, and outcome measures, most studies reported improvements in physical function, including mobility, muscle strength, walking capacity, and endurance, as well as enhanced performance in ADLs and reductions in fatigue. No serious adverse events were reported. Conclusions: Structured physical activity appears safe and may improve function and independence in patients with bone metastases. These findings support the integration of individualized exercise programs into multidisciplinary supportive care.
    Keywords:  Activities of Daily Living; advancer cancer; bone metastases; exercise intervention; movement; palliative care; physical function
    DOI:  https://doi.org/10.3390/cancers17193266
  5. Spine J. 2025 Oct 15. pii: S1529-9430(25)00860-5. [Epub ahead of print]
    Changes in Performance Status and Predictive Factors for Poor Improvement Following Surgery for Spinal Metastasis: A Nationwide Multicenter Prospective Cohort Study.
    JASA Study Group
       BACKGROUND CONTEXT: Spinal metastasis affects the activities of daily living (ADL) of patients, and spinal surgery is aimed at improving or maintaining ADL. The Eastern Cooperative Oncology Group Performance status (ECOG-PS) is a measure of ADL, and its change after surgery can influence decisions regarding cancer treatment options. However, few detailed, large-scale studies have examined changes in ECOG-PS after surgery for spinal metastases.
    PURPOSE: (1) To investigate the effects of spinal surgery for metastatic spinal tumors on ECOG-PS, and (2) To identify the risk factors for poor postoperative improvement.
    STUDY DESIGN: Prospective multicenter cohort study PATIENT SAMPLE: Four hundred and four symptomatic patients who underwent surgical treatment for metastatic spinal tumors.
    OUTCOME MEASURES: ECOG-PS was designated as the primary outcome and Barthel Index (BI) as the secondary outcome. Both were assessed preoperatively and at 1 and 6 months post-surgery.
    METHODS: Changes in ECOG-PS and BI were analyzed using the Friedman test or a general mixed-effect model. Poor outcomes were defined as a ECOG-PS score of 3, 4, or death. Preoperative factors associated with poor outcomes were analyzed using multivariate logistic regression analyses with complete or multiple imputed datasets.
    RESULTS: Preoperative ECOG-PS and BI scores improved at 1 and 6 months postoperatively. Patients with a ECOG-PS score of ≤2 at 1 month had significantly higher rates of receiving systemic therapy than those with a ECOG-PS score of ≥3. No use of bone-modifying agents, Frankel grade ≥ C, ECOG-PS score of ≥ 3, or a high C-reactive protein/albumin ratio (CAR) were the preoperative factors associated with poor PS at 1 month, whereas history of systemic therapy, ECOG-PS score of ≥ 3, primary tumor type, anemia, and high CAR were the preoperative factors associated with poor ECOG-PS at 6 months.
    CONCLUSION: Spinal surgery can improve ADL in patients with spinal metastases; however, not all patients experience favorable outcomes. The present findings indicate that the preoperative severity of paralysis and ADL impairment, laboratory data, and treatment history are important for predicting ADL after surgery for spinal metastasis.
    Keywords:  Activities of daily living; Anemia; Barthel Index; Bone-modifying agents; C-reactive protein/albumin ratio; Performance status; Spinal metastasis; Surgery
    DOI:  https://doi.org/10.1016/j.spinee.2025.10.028
  6. Phys Imaging Radiat Oncol. 2025 Oct;36 100840
    Radiological response assessment after stereotactic body radiotherapy for spine metastases using magnetic resonance imaging: a systematic review.
    Keivan Daneshvar, Mohammadamin Shahrbaf, Johannes Heverhagen, Katarina Bryjova, Daniel M Aebersold, Pejman Jabehdar Maralani, Arjun Sahgal, Matthias Guckenberger, Hossein Hemmatazad.
       Background and purpose: Magnetic resonance imaging (MRI) plays a central role in evaluating treatment response after stereotactic body radiotherapy (SBRT) for spinal metastases. However, current guidelines focus mainly on conventional MRI sequences and lack standardized, comprehensive criteria for post-treatment assessment. This systematic review aimed to summarize available evidence on MRI-based response assessment following spine SBRT, emphasizing the potential of advanced MRI techniques and computational tools to improve clinical decision-making.
    Materials and methods: We systematically searched PubMed, Scopus, Web of Science, and Embase from their inception to August 1, 2024. Two reviewers independently screened studies on MRI-based response assessment after SBRT for spinal metastases, evaluated eligibility, and extracted data on MRI techniques, response criteria, imaging biomarkers, and clinical outcomes.
    Results: Thirteen studies met the inclusion criteria. Tumor volume changes assessed by sagittal T1-weighted MRI, with a minimum detectable difference of approximately 11 %, were essential for evaluating local control. T2 signal alterations and reductions in dynamic contrast-enhanced (DCE) MRI perfusion parameters, such as Ktrans and Vp, correlated with improved outcomes, including pain relief and local control. Pseudo-progression and intralesional fatty content were identified as key imaging features that may mimic progression. Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping showed promise as response biomarkers, but lack clinical validation. Radiomics and machine learning models improved predictive accuracy for treatment outcomes and individual follow-up strategies.
    Conclusions: MRI provides essential morphological and functional biomarkers for response assessment after spine SBRT. Standardized, multi-parametric MRI protocols and computational tools are needed to optimize patient care.
    Keywords:  Magnetic resonance imaging; Response assessment; Spinal metastases; Stereotactic body radiotherapy
    DOI:  https://doi.org/10.1016/j.phro.2025.100840
  7. Chin Med Sci J. 2025 Sep 30. pii: 1001-9294(2025)03-0219-13. [Epub ahead of print]40(3): 219-231
    Cost-Effectiveness of Denosumab for Treating Bone Metastases from Solid Tumors: A Systematic Review (2017-2023).
    Cong Wang, Jin-Yu Liu, Min Wan, Qi Yuan, Yu Zhang, Guang-Yi Yu, Ru-Xu You.
       OBJECTIVES: This systematic review examines recent pharmacoeconomic literature on denosumab' cost-effectiveness for bone metastasis treatment, providing evidence-based insights to guide healthcare policy decisions.
    METHODS: A comprehensive literature search was performed across Cochrane, PubMed, EMBASE (Ovid), CNKI, and Wanfang databases to identify original articles published between 2017 and 2023. Key words consisted of bone metastases, denosumab, and cost-effectiveness in the search strategy. The methodological quality of the included studies was assessed utilizing the revised Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022). Data was extracted regarding methodological characteristics and cost-effectiveness analyses.
    RESULTS: A total of 111 studies were retrieved, of which 6 met the inclusion criteria. All included studies were based on clinical trials and published literature data and exhibited high methodological quality. Up to 83% (5 out of 6) of comparisons demonstrated that denosumab was more cost-effective or dominant compared to zoledronic acid. The adjusted incremental cost-effectiveness ratios varied substantially by tumor type, ranging from CZK 436,339.09 to USD 136,234 per skeletal-related event avoided and from CZK 61,580.95 to USD 118,392.11 per quality-adjusted life year gained.
    CONCLUSIONS: The majority of the included studies support denosumab as a more cost-effective treatment option for bone metastases in solid tumors compared to zoledronic acid. The application of CHEER (2022) enhances the reliability of pharmacoeconomic evaluations.
    Keywords:  bone metastases; cost‑effectiveness; denosumab; systematic review; zoledronic acid
    DOI:  https://doi.org/10.24920/004368
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