bims-rebome 2025-11-02 papers

J Clin Med. 2025 Oct 15. pii: 7279. [Epub ahead of print]14(20):

The Conundrum of Spinal Metastases-A Review of Current Management.

Bogdan Florin Iliescu, Daniel Ilie Rotariu, Loredana Mariana Agavriloaei, Bogdan Costachescu.

Spinal metastasis remains a significant clinical issue, frequently resulting in substantial pain and disability among cancer patients. Conventional management strategies have historically included chemotherapy, radiotherapy, and open surgical intervention. However, advancements in minimally invasive spinal surgery (MISS) have notably shifted the therapeutic landscape. This review examines recent evidence surrounding MISS, directly comparing it to traditional open procedures. Current literature demonstrates that MISS typically results in reduced intraoperative blood loss, shorter hospitalization durations, decreased infection rates, and functional outcomes that are at least equivalent-if not superior-to those of open surgery. Additionally, the emergence of hybrid therapeutic approaches-specifically, the utilization of separation surgery followed by stereotactic radiosurgery-has shown promise in achieving local tumor control, particularly in select malignancies. This narrative review also evaluates contemporary clinical decision-making frameworks such as NOMS, LMNOP, and NESMS. Further, it advocates for the integration of advanced prognostic tools and tumor genomics to enable more personalized treatment strategies for individuals with spinal metastasis.

Keywords: minimally invasive spinal surgery (MISS); neuro-oncology; spinal metastasis

DOI: https://doi.org/10.3390/jcm14207279

Oncologist. 2025 Oct 25. pii: oyaf363. [Epub ahead of print]

Prediction of survival in patients suffering from spinal metastases: A prospective, multicenter validation study.

Ronald H M A Bartels, Karel de Bree, Hassan Pazira, Martine van Bilsen, Marianne Jonker, Godard C W de Ruiter, Mark Arts, Paulien Westhoff.

BACKGROUND: The treatment of patients with symptomatic spinal metastasis is challenging, and it warrants a multi-disciplinary approach. When surgery is considered, the expected survival time at three months might be an important argument in the discussion. With the advent of new treatment modalities, however, validation of an existing prediction model is warranted.
METHODS: Validation study with inclusion of patients after informed consent from May 2021 through December 2023 in one academic hospital and two large non-academic medical centers. Information was collected on the following variables: sex, primary tumor type, treatment of the primary tumor with curative intention, cervical location of the metastasis, and the highest Karnofsky Performance Score in 24 hours before presentation. The validation set included 378 patients with symptomatic spinal metastasis. The derivation set consisted of 567 patients. The main outcome are C-index, calibration slope, D-statistic, R2D, Brier score, joint test for misspecification.
REULTS: The model had a C-index value of 0.68 ± 0.02 (95% CI: 0.64-0.72). Calibration analysis yielded a calibration slope of 0.66 ± 0.09 (95% CI: 0.50-0.83). The D-statistic was 0.92, and the R2D value was 0.17. The model performed well, especially at three months, with a Brier score of 0.44. Although no mismatch was observed graphically, the joint test for misspecification yielded a statistically significant value. The model was therefore adjusted slightly, based on all 945 patients included in the original model and the current study.
CONCLUSION: The prediction model performed reasonably well in estimating survival at three months in patients with symptomatic spinal metastasis.

Keywords: Prediction model; Spinal Surgery; Spinal metastasis; Survival

DOI: https://doi.org/10.1093/oncolo/oyaf363

World J Surg. 2025 Oct 28.

Survival Outcomes in Breast Cancer Patients With Metastatic Bone Disease.

Gerard J Hill, Aisling Hegarty, Gavin P Dowling, Sandra Hembrecht, Gordon R Daly, Trudi Roche, Eithne Downey, Michael Allen, Colm Power, Nuala Healy, Leonie S Young, Arnold D K Hill.

OBJECTIVE: To evaluate the survival outcomes of breast cancer patients with metastatic bone disease and to assess whether these patients exhibit different prognoses compared to those with more extensive metastatic involvement.
BACKGROUND: Systemic therapy including endocrine therapy, chemotherapy and targeted agents remains the cornerstone of treatment for patients with stage IV breast cancer, particularly those with bone metastases. Palliative radiotherapy also plays a key role in bone metastases, especially for symptom control and managing skeletal and complications. Although these modalities have significantly improved outcomes, the prognostic variation among patients with bone-only disease-ranging from solitary to widespread metastases-warrants further investigation. This study aims to evaluate survival outcomes among breast cancer patients with varying patterns of bone metastases.
METHODS: This retrospective cohort study analyzed data from 4000 breast cancer patients treated between 2006 and 2024. Patients were evaluated for bone metastases, which were confirmed through imaging reviewed via the Picture Archiving and Communication System (PACS). Patients with confirmed bone metastases were categorized into solitary, oligometastatic (2-5 sites), or multiple metastases groups. Data on demographics, tumor characteristics, treatment regimens, surgery types, and survival outcomes were collected. Survival analyses were conducted using Kaplan-Meier curves and compared using log-rank tests.
RESULTS: One hundred and eighty-seven patients with metastatic bone disease were identified. 21 patients had solitary bone metastases only with a mean survival of 14.6 years. Additionally, 30 patients had oligometastatic bone disease only with a mean survival of 7 years. Another 31 patients had multiple bone only metastases, with also a mean survival of 7 years. Finally, 105 of the 187 patients had other metastases alongside bone metastases in other organs including the lung, liver, and brain with a mean survival of 6.3 years.
CONCLUSION: These findings suggest that patients with bone-only metastases, particularly those with solitary lesions, exhibit significantly longer survival. Although systemic therapy remains the standard these findings suggest that patients with bone-only metastases, particularly those with solitary lesions, exhibit significantly longer survival. Although systemic therapy remains the standard, these findings highlight the need for further research into whether selected patients may benefit from integrating local treatment approaches, including surgery, into their management.

Keywords: bone metastasis; breast cancer; survival

DOI: https://doi.org/10.1002/wjs.70147

N Am Spine Soc J. 2025 Dec;24 100794

A systematic review on frailty indices utilized in oncologic surgery and radiotherapy for metastatic spine disease: A critical appraisal of components and performance.

Ali Haider Bangash, Rose Fluss, Sertac Kirnaz, Jason D Nosrati, Byung-Han Rhieu, Justin Tang, Madhur K Garg, Saikiran G Murthy, Yaroslav Gelfand, Reza Yassari, Rafael De la Garza Ramos.

Background: Frailty assessment is becoming increasingly important for risk stratification in metastatic spine disease (MSD) management. However, the optimal frailty assessment tool for this population remains undefined. The aim of this systematic review was to critically evaluate frailty indices utilized in surgical and radiotherapeutic management of MSD by appraising their components and predictive performance.
Methods: We systematically searched PubMed, Cochrane, and Epistemonikos from inception until November 13, 2024 for studies exploring frailty indices in MSD management. Methodological quality assessment was undertaken using the Methodological index for nonrandomized studies (MINORS) and Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tools. We evaluated indices for comprehensiveness by assessing if they included measures across 8 dimensions (comorbidity burden, mobility, cognition, mood, social vulnerability, nutrition, energy, and function). We also assessed their predictive utility for mortality and complications.
Results: Out of a total of 42 studies, 15 studies reporting on 61,663 patients (Mean age: 63 years; 44% female) met the inclusion criteria. All studies were of moderate quality based on MINORS analysis. Six frailty indices were identified, with all including comorbidities while none incorporating energy measures. The Hospital Frailty Risk Score was the most comprehensive (75% of frailty spectrum). Predictive performance varied considerably across studies, with inconsistent associations with complications and mortality after both: surgical and radiotherapeutic interventions.
Conclusions: Contemporary frailty indices showed substantial heterogeneity in both composition and predictive performance for MSD outcomes. The inconsistent performance and incomplete capture of frailty dimensions underscored the need for developing a novel frailty index that incorporates oncologic factors and balances comprehensive evaluation with clinical feasibility to help guide treatment decisions between surgery and radiotherapy for patients with MSD.

Keywords: Frailty; Frailty index; Metastatic spinal tumor frailty index; Metastatic spine disease; Radiotherapy; Surgery

DOI: https://doi.org/10.1016/j.xnsj.2025.100794

J Palliat Med. 2025 Oct 15.

Trends in Palliative Care Utilization in Patients with Bone Metastases.

Dana G Rowe, Joshua Woo, Seeley Yoo, Ellen O'Callaghan, Nicole Rivera, Kerri-Anne Crowell, Tara Dalton, Elizabeth Fricklas, Christopher A Jones, Julia Visgauss, Victoria Bradley, Trey C Mullikin, Margaret O Johnson, Melissa M Erickson, C Rory Goodwin.

Background: Bone metastases cause significant symptom burden, yet patterns of palliative care (PC) utilization in this population remain poorly characterized. Objectives: To evaluate trends in PC use, compare inpatient palliative care (IPPC) and outpatient palliative care (OPPC) utilization, identify predictors of PC engagement, and assess the impact on readmissions. Methods: Using the PearlDiver database (2011-2021), patients with bone metastases were identified. PC encounters were classified as IPPC or OPPC. Trends were assessed with linear regression; predictors and outcomes were evaluated using multivariate logistic regression. Results: Of 471,713 patients, 17.2% received PC. Overall PC use did not increase significantly from 2011 to 2021 (p = 0.14), though OPPC rose from 0.7% to 2.6% (R2 = 0.87). Predictors of PC use included younger age (mean age 64 vs. 66 years, p < 0.001), female gender, higher comorbidity burden, Medicaid insurance, and region (p < 0.01 for all). Receipt of OPPC within six months of hospice was associated with 77% lower odds of readmission (Odds Ratio (OR): 0.23, 95% Confidence Interval (CI): 0.17-0.30, p < 0.001). Conclusion: PC utilization remains low in this population. OPPC use has modestly increased and is associated with reduced readmissions prior to hospice referral. Expanding OPPC may reduce hospitalizations and improve care quality.

Keywords: bone metastases; metastatic cancer; palliative care; palliative medicine; support services

DOI: https://doi.org/10.1177/10966218251388233