bims-rebome 2025-11-30 papers

Unfallchirurgie (Heidelb). 2025 Nov 26.

[Vertebral body metastases : From the clarification of back pain to the treatment decision].

Doris Lachmann, Klaus-Dieter Schaser, Julia Luckow, Alexander C Disch.

Vertebral body metastases represent one of the most frequent manifestations of skeletal tumor dissemination and must be considered in the differential diagnosis of unexplained back pain, particularly in patients with a known history of oncological diseases. The associated morbidity, including spinal instability, deformity, pathological fractures and severe pain, is substantial. Healthcare professionals are regularly confronted with this complex clinical scenario in both outpatient and inpatient settings. A thorough medical history, especially the identification of red flags (e.g., prior trauma and/or malignancy) is critical. Early initiation of appropriate imaging studies, timely evaluation of the clinical urgency and expedited referral to specialized spine centers constitute the foundation for effective interdisciplinary treatment planning. This article outlines the key diagnostic and organizational principles required for the evaluation and further management of patients with vertebral metastases.

Keywords: Back pain; Biopsy; Imaging; Interdisciplinary therapy; Spinal instability

DOI: https://doi.org/10.1007/s00113-025-01655-x

Cancer Treat Rev. 2025 Nov 19. pii: S0305-7372(25)00173-2. [Epub ahead of print]142 103051

Bone metastases in NSCLC: Modern paradigms in management and supportive care.

Gabriele Minuti, Giorgia Pasqualini, Alice Avancini, Niccolò Giaj-Levra, Francesca Colonese, Alessandro Di Federico, Alessandra Fozza, Michele Montrone, Emanuela Olmetto, Edoardo Pastorello, Maria Lucia Reale, Silvia Teresa Riva, Elisa Roca, Claudio Sini, Giuseppe Viscardi, Sara Pilotto, Francesco Passiglia.

Bone metastases (BoMs) are a frequent complication in advanced non-small-cell lung cancer (NSCLC), affecting approximately one third of patients at diagnosis and 35-60 % during the disease course. BoMs increase the risk of skeletal-related events (SREs), which have a detrimental impact on prognosis, performance status, and quality of life (QoL). Management of BoMs in NSCLC requires a multimodal approach. Although systemic anti-cancer therapies remain the cornerstone, the optimal management of BoMs in NSCLC also encompasses bone-targeted agents (BTAs) such as bisphosphonates and denosumab, local treatments including radiotherapy and surgical interventions, and supportive care strategies aimed at preventing SREs, alleviating pain, preserving mobility, and maintaining QoL. This review provides an updated overview of best practices for managing BoMs in NSCLC, covering diagnostic work‑up, therapeutic strategies, and the growing role of multidisciplinary care. It emphasizes the importance of supportive interventions, including nutrition and physical activity, to optimize outcomes in the era of targeted and immune-based therapies, alongside comprehensive simultaneous care.

Keywords: Bone metastases; Bone-targeted agents; Exercise; Non-small cell lung cancer; Nutrition; Radiotherapy; Surgery

DOI: https://doi.org/10.1016/j.ctrv.2025.103051

Radiother Oncol. 2025 Nov 22. pii: S0167-8140(25)05304-6. [Epub ahead of print]214 111300

International consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases: A second update.

International Bone Metastases Consensus Working Party

BACKGROUND AND PURPOSE: External beam radiotherapy (EBRT) is a well-established and effective intervention for pain palliation in patients with bone metastases. Variability in trial endpoints, however, has limited comparability and synthesis of available evidence. To address this, the International Bone Metastases Consensus Working Party published endpoint guidelines in 2002 and updated them in 2012. This study aims to review, re-evaluate, and update the existing consensus to reflect contemporary clinical practice and technological advances.
MATERIALS AND METHODS: A modified Delphi process was undertaken, informed by a systematic literature review and post-2012 guideline publications. An electronic survey was distributed to previous contributors and internationally recognized bone EBRT experts. In Phase I, statements achieving ≥ 75 % agreement were accepted. Items not reaching consensus were refined by the Working Party, discussed by a core panel of eight experts, and recirculated in Phase II. Descriptive statistics summarized response rates and agreement levels.
RESULTS: Of 125 experts invited, 58 participated in Phase I, and 44 in Phase II. Consensus was achieved for 38 out of 49 statements (78%), including 18 new or revised items. Key recommendations addressed eligibility criteria for trial enrolment, standardized pain and analgesic assessments, specification of radiation techniques and dose schedules, follow-up intervals, assessment timing and modalities, and incorporation of cost-effectiveness analyses.
CONCLUSION: This updated consensus provides a contemporary, standardized framework for EBRT trial design and reporting in bone metastases. Adoption will improve cross-study comparability and guide future research priorities. Regular updates are planned to ensure alignment with evolving clinical practice and technology.

Keywords: Bone metastases; Clinical trials; Consensus guidelines; Delphi Method; External beam radiotherapy; Palliative radiotherapy; Trial endpoints

DOI: https://doi.org/10.1016/j.radonc.2025.111300