bims-rebome 2026-01-11 papers

Ann Med Surg (Lond). 2026 Jan;88(1): 381-386

Contemporary management strategies for spinal metastases: diagnosis, multidisciplinary approaches, and outcomes - a narrative review.

Kanav Gupta, Sonal Gupta, Rakesh Dua, Shivanya Singh, Kavya Gupta, Bipin Chaurasia.

Background and Objective: Spinal metastases occur in 30%-70% of cancer patients, with approximately 10%-20% experiencing symptomatic manifestations including pain, instability, or neurological deficits. Nearly 20% of patients present with malignant spinal cord compression as their initial manifestation of malignancy. Our objectives were to provide a comprehensive review of contemporary management strategies for spinal metastases, focusing on diagnostic approaches, multidisciplinary treatment frameworks, and surgical interventions that optimize patient functional outcomes and quality of life.
Methods: SANRA-guided narrative review of PubMed, EMBASE, and Cochrane Library (2000-2025). Clinical trials, meta-analyses, consensus statements, and seminal papers were prioritized; purposive selection ensured broad thematic coverage. The analysis encompasses imaging techniques, surgical interventions, and decision-making frameworks including the NOMS (Neurologic, Oncologic, Mechanical, and Systemic) classification system.
Results: Within the spinal column, metastases most commonly affect the thoracic region, followed by lumbar and cervical regions. Common primary tumors with high bone metastasis rates include breast (72%), prostate (84%), thyroid (50%), lung (31%), kidney (37%), and pancreas (33%), collectively accounting for more than 80% of spinal metastases cases. Magnetic resonance imaging demonstrates the advantage of detecting multilevel involvement without radiation exposure. Contemporary management employs a multidisciplinary approach incorporating chemotherapy, radiotherapy, and surgical interventions. Modern surgical approaches have evolved from historical laminectomy-only procedures to comprehensive decompression with stabilization techniques.
Conclusions: Early recognition and prompt intervention remain critical for preventing irreversible neurological deficits and optimizing patient outcomes. Future improvements in molecular targeted therapies, imaging precision, and surgical techniques promise continued enhancement of treatment outcomes for patients with spinal metastases.

Keywords: NOMS framework; metastatic spinal cord compression; minimally invasive surgery; radiotherapy (SBRT/SRS); spinal metastases

DOI: https://doi.org/10.1097/MS9.0000000000004209

Ann Med Surg (Lond). 2026 Jan;88(1): 510-521

Advancements in metastatic spinal cord compression treatment: a narrative review of innovations, challenges, and future directions.

Tirath Patel, Fathimathul Henna, Iman Sharif, Anaya Noor, Hafiza Tooba Siddiqui, Zarhaish Barkat-Ullah, Mahnoor Ishaque, Najia Ali Khan, Christopher Hanani, Abhishek Goyal, Nikhilesh Anand.

Objective: To synthesize recent advancements in metastatic spinal cord compression (MSCC) treatment, evaluating their efficacy in improving neurological function, pain relief, survival, and quality of life.
Background: MSCC is an oncologic emergency caused by the progression of cancer to the spine and is prevalent in approximately 3-5% of all cancer patients, with a relatively higher incidence of breast, prostate, and lung cancers. MSCC can lead to irreversible paralysis due to loss of vital sensory and motor functions, thus requiring an immediate diagnosis and treatment.
Methods: A systematic PubMed search identified studies published over the past 5 years focusing on advancements in MSCC treatment. Applying the PICO criteria, 132 articles were retrieved, of which 38 met the inclusion criteria after rigorous screening.
Result: Effective care of MSCC includes high-dose corticosteroids, surgery, and radiation therapy. Advancements such as robot-assisted and minimally invasive surgeries enhance surgical outcomes. Emerging technologies, including deep learning models for early detection and automated MRI analysis, improve diagnostic accuracy. Personalized medicine techniques, such as next-generation sequencing, enable the development of customized therapies tailored to individual tumor characteristics. Innovations such as bioengineered implants provide better imaging compatibility and reduce radiation scattering. Proton therapy delivers targeted radiation with minimal harm to adjacent tissues.
Conclusion: Prompt, multimodal treatment is necessary, including corticosteroids, surgery, and radiation therapy to reduce symptoms and enhance patient outcomes. Despite advancements, challenges such as delayed diagnosis and limited access to specialized treatments persist. Precision medicine, artificial intelligence-based diagnostics, and easier access to clinical trials should be the main areas of future development. Preventing irreparable neurological impairments and improving patient quality of life requires a focus on palliative care and early intervention. Integrating innovative therapies with comprehensive supportive care in a patient-centered study is essential for enhancing neurological function, pain control, and overall quality of life.

Keywords: artificial intelligence (AI); metastatic spinal cord compression (MSCC); minimally invasive surgery; personalized medicine; proton therapy

DOI: https://doi.org/10.1097/MS9.0000000000004382

Cancers (Basel). 2025 Dec 24. pii: 61. [Epub ahead of print]18(1):

Palliative Performance Scale Predicts Survival in Patients with Bone Metastasis Undergoing Radiotherapy.

Gina Hennig, Emma Thrandorf, Dirk Vordermark, Jörg Andreas Müller.

BACKGROUND: Accurate prognostication is essential for clinical decision-making in palliative radiotherapy (RT). The Palliative Performance Scale (PPS) is a validated tool for assessing functional status and estimating survival in palliative care, yet its prognostic value in patients receiving palliative RT for bone metastases remains insufficiently explored. This study aimed to evaluate the association between PPS and overall survival (OS) in a real-world cohort of cancer patients undergoing palliative RT.
METHODS: This retrospective, single-center study included 153 patients who received palliative RT for bone metastases between 2021 and 2025 at the Department of Radiation Oncology, University Hospital Halle (Saale), Germany. Clinical, demographic, and treatment data were extracted from institutional databases. The primary endpoint was OS, defined as the time from the end of RT to death. Univariable and multivariable Cox proportional hazards regression models were used to identify prognostic factors associated with OS, including PPS, sex, age, marital status, BMI, Charlson Comorbidity Index (CCI), and RT completion. Due to violation of the proportional hazards assumption, PPS (<60% vs. ≥60%) was used as a stratification factor in the final Cox model. Logistic regression was performed to explore predictors of discharge to home.
RESULTS: The median OS for the entire cohort was 108 days (3.6 months; 95% CI 78-143 days). Male sex (HR 1.61, 95% CI 1.06-2.46, p = 0.027) and older age (HR 0.98, 95% CI 0.96-1.00, p = 0.050) were associated with shorter survival, whereas completion of the prescribed RT course was strongly associated with improved OS (HR 0.06, 95% CI 0.03-0.12, p < 0.001). Patients with PPS ≥60% had significantly better survival compared to those with lower PPS (HR 0.62, 95% CI 0.41-0.93, p = 0.021). After stratification by PPS, no violation of the proportional hazards assumption was detected (global p = 0.55). The stratified model confirmed that male sex, age, and RT completion remained independent predictors of survival. No significant predictors were identified for discharge destination in logistic regression analysis.
CONCLUSIONS: The PPS is a valuable prognostic tool for patients receiving palliative RT for bone metastases. A PPS of ≥60% was associated with prolonged survival, supporting its use in clinical prognostication and treatment planning. Completion of RT emerged as a strong independent predictor of survival, underscoring the importance of treatment adherence even in palliative settings. Stratification by PPS further improved model validity and prognostic accuracy.

Keywords: bone metastasis; palliative performance scale; palliative radiotherapy; survival

DOI: https://doi.org/10.3390/cancers18010061

Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2025 Dec;33(6): 1635-1639

[Analysis of Clinical Characteristics and Risk Factors for Bone Lesions in Patients with Multiple Myeloma].

Chen-Yang Li, Qi-Ke Zhang, Xiao-Fang Wei, You-Fan Feng, Yuan Fu, Qiao-Lin Chen, Wen-Jie Zhang, Yuan-Yuan Zhang, Shao-Hua Zhang, Shang-Yi Zhang, Jie Liu.

OBJECTIVE: To investigate the clinical characteristics of patients with multiple myeloma (MM) complicated by bone lesions and the risk factors associated with bone lesions.
METHODS: The clinical data of 294 newly diagnosed MM patients in Gansu Provincial Hospital from January 2017 to June 2021 were retrospectively analyzed. The patients were divided into the bone lesion group (154 cases) and the non-bone lesions group (140 cases) based on the presence of absence of bone lesions at diagnosis. The general data and laboratory parameters were compared between the two groups. The risk factors for bone lesions in MM patients were analyzed by logistic regression analysis, and the characteristic (ROC) curves were plotted to assess the predictive value of each risk factor for the occurrence of bone lesions in MM patients.
RESULTS: Compared to the non-bone lesion group, the bone lesion group had significantly higher serum calcium levels and significantly greater proportions of patients with Durie-Salmon (DS) stage III, and bone pain (all P < 0.05). Logistic regression analysis showed that elevated serum calcium (OR =5.135, 95%CI : 1.931-13.653, P =0.001), DS stage III (OR =1.841, 95%CI : 1.019-3.328, P =0.043), and bone pain (OR=8.208, 95%CI : 4.761-14.151, P < 0.001) were independent risk factors for bone lesions in MM patients. ROC curve analysis showed that serum calcium (AUC=0.619, 95%CI : 0.555-0.683, P < 0.001) and bone pain (AUC=0.743, 95%CI : 0.692-0.793, P < 0.001) had predictive value for bone lesions in MM patients.
CONCLUSION: MM patients have a high incidence of bone lesions, and active monitoring and management of risk factors may improve treatment outcomes and prognosis.

Keywords: multiple myeloma; Durie-Salmon stage; risk factors; bone lesions

DOI: https://doi.org/10.19746/j.cnki.issn.1009-2137.2025.06.013

JOR Spine. 2026 Mar;9(1): e70111

Metastatic Spine Disease Alters Vertebral Load-To-Strength Ratios in Cancer Patients Compared to Healthy Individuals.

Dennis E Anderson, Mario Keko, Joanna James, Brett T Allaire, David Kozono, Patrick F Doyle, Heejoo Kang, Sarah Caplan, Tracy Balboni, Alexander Spektor, Mai Anh Huynh, Mary L Bouxsein, David B Hackney, Ron N Alkalay.

Purpose: This study investigated the effect of bone metastasis on the biomechanical environment of human vertebrae in patients with metastatic spine disease through the metric of load-to-strength ratio (LSR). Specifically, we compared the patients' LSRs to age and sex-similar noncancer controls from the Framingham Heart Study.
Methods: Derived from clinical CT data of 135 metastatic spine disease patients planned for radiotherapy and 246 normative controls from the Framingham Heart Study, individualized spinal musculoskeletal models and vertebral strength estimates were used to compute level-specific LSR under natural standing and three weight-holding conditions (standing + weight, flexion + weight, and lateral bending + weight).
Results: Adjusted for age, BMI, and spinal region, osteosclerotic and mixed lesion vertebrae had higher strength than osteolytic and control vertebrae. The musculoskeletal models suggested breast, prostate, and male lung cancer patients had higher compressive vertebral loading, and female lung cancer patients had lower compressive vertebral loading than controls. Male patients had higher standardized LSRs in natural standing, while female patients had lower LSRs for all activities than controls. Independent of sex, vertebrae with osteosclerotic and mixed bone metastasis had lower LSRs than controls, while, for osteolytic bone lesions, males had higher and females lower LSRs than controls. Vertebrae with no observed lesion on CT had higher LSRs than controls in males and lower LSRs in females.
Discussion: Our findings highlighted that primary cancer and lesion type differentially affected task-specific vertebral loading and strength, thus modifying the vertebral LSRs. Sex-mediated differences in LSRs between FHS controls and vertebrae with no observed metastatic lesions suggest that considering the latter as "normal" should be taken with care. Our initial assessment supports further examination of whether vertebral LSR measurements are associated with vertebral risk and, if so, what threshold values indicate risk.
Level of Evidence: 3.

Keywords: load‐to‐strength ratio; metastatic spinal disease; musculoskeletal models; pathologic vertebral fracture; patient cohort; vertebral strength

DOI: https://doi.org/10.1002/jsp2.70111