bims-rebome Biomed News
on Management of bone metastases
Issue of 2026–03–01
fifteen papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata
  1. AO Spine Clinical Practice Recommendations: An Overview of the Current State of Fusion Surgery for Patients With Spinal Metastasis: Is Fusion Necessary?
  2. Multidisciplinary approach to bone metastases: a single center experience in a tertiary cancer center.
  3. Denosumab Plus Immune Checkpoint Inhibitors in Bone Metastases From Solid Tumors.
  4. Comparative Effectiveness and Safety of Denosumab Versus Bisphosphonates in Elderly Patients with Cancer Bone Metastases: A Target Trial Emulation Study.
  5. Theranostics of Bone Metastases: The Role and Prospects of Bisphosphonate Radiopharmaceuticals.
  6. Bibliometric analysis of bone metastasis from prostate cancer research from 2007 to 2024.
  7. Development and validation of the Home time and Overall survival after Metastatic spine tumor surgery Estimator (HOME score).
  8. Post-operative survival and use of systemic therapy in metastatic long-bone disease: 12 years of institutional experience.
  9. The Neuro-Bone Axis in Metastatic Progression: Innervation, Neuro-Immune-Osteoclast Crosstalk, and Therapeutic Opportunities.
  10. Prospective Evaluation of Stereotactic Body Radiation Therapy for Reirradiation of Bone Metastases.
  11. Minimally Invasive Stabilization Versus Open Surgery for Spinal Metastases: A Retrospective Study Utilizing Propensity Score Matching and Weighting Sensitivity Analyses.
  12. Prognostic comparison between osteoblastic and osteolytic metastases in prostate cancer.
  13. The influence of immunohistochemistry-based subtypes on overall survival in breast cancer spine metastases: a systematic review and meta-analysis.
  14. The Use of Radiotherapy in Leptomeningeal Carcinomatosis: A Systematic Review and Random-Effects Proportions Meta-Analysis.
  15. Multimodal Management of Metastatic Brachial Plexopathy in Breast Cancer.
  1. Global Spine J. 2026 Feb 22. 21925682261426936
    AO Spine Clinical Practice Recommendations: An Overview of the Current State of Fusion Surgery for Patients With Spinal Metastasis: Is Fusion Necessary?
    Federico Landriel, Fabio Cofano, Santiago Matías Hem, Syed Muhammed Karim, Ankit I Mehta, Ori Barzilai, Nicolas Dea, Alessandro Gasbarrini, C Rory Goodwin, Ilya Laufer, Jeremy Reynolds, Jorrit-Jan Verlaan, Charles G Fisher, Cordula Netzer.
      Study DesignLiterature review with clinical recommendations.ObjectiveProviding a clear and concise overview based on the of key literature and consensus expert opinion on spinal fusion following stabilization for spine metastases and offer actionable recommendations on when to fuse and not fuse in this patient population.MethodsKey articles from the published literature on spinal metastases treated with stabilization followed by fusion were reviewed, and clinical recommendations were formulated. The recommendations are categorized as either strong or conditional based on an assessment of methodological quality and expert opinion. This assessment considers factors such as experience, risks, burdens, costs, patient values, and circumstances.ResultsFour articles were selected by practicing spinal oncology surgeons and each was evaluated for its methodological strength and its scientific evidence.ConclusionFusion rarely influences clinical outcomes in metastatic spine surgery. Treatment should prioritize mechanical stability, pain control, functional preservation, and timely continuation of oncologic therapy rather than pursuing bony arthrodesis. Fusion should be considered exclusively in select long-surviving patients, however routine attempts to enhance fusion or delay adjuvant therapy are not justified.[Formula: see text].
    Keywords:  bone grafts; fusion rate; hardware failure; literature review; outcome; pseudarthrosis; spinal metastases; surgical site infection; wound healing complications
    DOI:  https://doi.org/10.1177/21925682261426936
  2. Support Care Cancer. 2026 Feb 27. pii: 256. [Epub ahead of print]34(3):
    Multidisciplinary approach to bone metastases: a single center experience in a tertiary cancer center.
    Chiara Pittarello, Antonella Brunello, Evelina Lamberti, Stefania Zovato, Fabio Formaglio, Sara Galuppo, Marco Krengli, Ugo Nena, Andrea Angelini, Piero Ruggieri, Virginia Pozza, Giovanna Pintacuda, Alice Pittaro, Vittoria Aldegheri, Melissa Ballestrin, Anna Roma, Sara Lonardi, Valentina Guarneri, Cristina Falci, Marco Maruzzo.
       PURPOSE: The increasing incidence of bone metastases frequently leads to skeletal-related events (SREs) and pain. While multidisciplinary management is recommended by scientific societies, a standardized model remains undefined. An example can be provided by the Osteoncology multidisciplinary outpatient clinic (OMC) of the Veneto Oncology Institute, created to offer support to patients with bone metastases.
    PATIENTS AND METHODS: Patients with bone metastases are evaluated by a multidisciplinary team since 2013. Access to the OMC is regulated by an internal protocol and a form filled out by the referring physicians, which establishes the priority of access and the specific query for the multidisciplinary team. We analyzed the characteristics and outcome of OMC visits of all patients who accessed between January 2018 and June 2023. All data were retrieved from a prospectively managed database.
    RESULTS: 2,200 patients were evaluated at OMC, with a median age of 66 years. Breast (33.3%) and lung cancer (19.2%) were the most frequent primary sites. Most patients (85.1%) accessed the OMC in line with the priority indicated by their referral score, with a median waiting time of 6 days. Physicians most frequently asked the multidisciplinary team about the best treatment for bone metastases; 35% sent multiple requests. Following OMC visit, 31.5% of patients received two or more distinct indications. The most frequent were orthopedic corsets (28.3%) and radiotherapy (27.5%).
    CONCLUSION: This large series confirms the efficacy of a multidisciplinary approach for bone metastases. This method reduces patients' psychophysical stress through rapid and effective assessment and provide precise and tailored therapeutic indications.
    Keywords:  Bone metastasis; Multidisciplinary; Osteoncology; Skeletal disease
    DOI:  https://doi.org/10.1007/s00520-026-10476-6
  3. Cancer Control. 2026 Jan-Dec;33:33 10732748261427063
    Denosumab Plus Immune Checkpoint Inhibitors in Bone Metastases From Solid Tumors.
    Na Wang, Feixue Song, Xiangkai Li, Hao Chen.
      Bone metastases are a common and devastating complication of advanced solid tumors, significantly impairing patients' quality of life and prognosis. Immune checkpoint inhibitor (ICI) plus bone-targeted therapies have emerged as a promising strategy to improve outcomes in patients with bone metastases. Denosumab, a fully human mAb targeting RANKL, can inhibit osteoclast-mediated bone resorption and prevent skeletal-related events. Beyond its direct bone remodeling activity, denosumab can also modulate the immune microenvironment, enhance anti-tumor immunity by reducing the release of immunosuppressive factors into the bone milieu, and improve vascular integrity within previously damaged bone tissue to facilitate immune cell infiltration into the metastatic niches. ICIs restore T-cell activity by overcoming tumor-induced immune suppression, thereby enabling more effective anti-tumor responses. Emerging evidence have suggested a potential synergy of denosumab plus ICIs, mechanistically by reinvigorating T-cell function and promoting maturation and antigen-presenting capacity of dendritic cells to further amplify adaptive immune response against metastatic bone tumors. The present narrative review summarizes the preclinical and clinical findings on this combination and discusses potential biomarkers and current challenges for the optimization of patient selection and therapeutic paradigm. Besides, we briefly overview current ongoing studies that investigate the potential antitumor synergy with denosumab plus ICIs in bone metastases.
    Keywords:  bone metastases; denosumab; immune checkpoint inhibitors; solid tumors
    DOI:  https://doi.org/10.1177/10732748261427063
  4. Life (Basel). 2026 Feb 17. pii: 346. [Epub ahead of print]16(2):
    Comparative Effectiveness and Safety of Denosumab Versus Bisphosphonates in Elderly Patients with Cancer Bone Metastases: A Target Trial Emulation Study.
    Che-Wei Liu, Shun-Neng Hsu, Shao-Hsuan Chang, Wei-Cheng Chang, Chun-Liang Hsu, Hsin-Yu Chen, Po-Huang Chen, Cho-Hao Lee.
      Objective: Bone-modifying agents (BMA) are central to the prevention of skeletal-related events (SREs) in patients with cancer bone metastases, yet evidence guiding agent selection in very old patients remains limited. This study aimed to compare the effectiveness and safety of Denosumab versus bisphosphonates in patients aged ≥75 years with solid tumour-related bone metastases using a target trial emulation framework. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network to emulate a hypothetical randomised trial. Patients aged ≥75 years with solid tumour-related bone metastases initiating Denosumab or bisphosphonates were included. After 1:1 propensity score matching (PSM), 10,662 patients were analysed in each treatment group. The primary outcome was time to first SRE. Secondary outcomes included individual SRE components, all-cause mortality, and safety events. Results: Among 21,324 matched patients (mean age, 75.6 years), bisphosphonate use was associated with a higher risk of SREs compared with Denosumab (hazard ratio [HR], 1.15; 95% CI, 1.06-1.25). The excess risk was driven by pathological fractures (HR, 1.28; 95% CI, 1.10-1.49), whereas other SRE components did not differ significantly. All-cause mortality was higher among bisphosphonate users (HR, 1.41; 95% CI, 1.33-1.49, p < 0.001). Hypocalcaemia occurred more frequently with Denosumab (5.7% vs. 2.4%), while risks of acute kidney injury and end-stage renal disease (ESRD) were similar. Findings were consistent across sensitivity and subgroup analyses. Conclusions: In patients aged ≥75 years with solid tumour-related bone metastases, Denosumab was associated with lower risks of skeletal-related events-particularly pathological fractures-and reduced all-cause mortality compared with bisphosphonates. These results extend randomised trial evidence to a clinically vulnerable population and support Denosumab as a preferred BMA in older adults.
    Keywords:  Denosumab; bisphosphonates; bone metastases; skeletal-related events; target trial emulation
    DOI:  https://doi.org/10.3390/life16020346
  5. Pharmaceuticals (Basel). 2026 Feb 10. pii: 295. [Epub ahead of print]19(2):
    Theranostics of Bone Metastases: The Role and Prospects of Bisphosphonate Radiopharmaceuticals.
    Yu Qian, Guangxing Yin, Yuhao Jiang, Peiwen Han, Junbo Zhang.
      Bone metastasis is among the most common complications of advanced malignant tumors and severely affects prognosis in patients. Nuclear medicine, particularly bone-targeted radiopharmaceuticals, plays a unique and pivotal role in the diagnosis and treatment of bone metastases. This review systematically outlines the evolutionary trajectory of bone-targeted radiopharmaceuticals. It revisits functional bone imaging agents based on Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET), as well as recently developed therapeutic radiopharmaceuticals for bone metastases. Building on this foundation, this article focuses on the advanced paradigm of "theranostics" in nuclear medicine, encompassing strategies for theranostic radionuclide pairing and the development of single-radionuclide theranostic agents, aiming to achieve individualized and precise dosimetry. Moreover, this review emphasizes bone-targeting molecular scaffolds, such as bisphosphonates, and highlights their potential and direction for optimization through rational drug design, with the goal of developing a new generation of highly effective and low-toxicity theranostic platforms. This work aims to provide systematic insights for enhancing the precise management of bone metastases.
    Keywords:  bisphosphonates; bone imaging; bone metastasis; radiopharmaceutical; theranostics
    DOI:  https://doi.org/10.3390/ph19020295
  6. Discov Oncol. 2026 Feb 23.
    Bibliometric analysis of bone metastasis from prostate cancer research from 2007 to 2024.
    Yin He, Jing Zhang, Kai Gong, Zhilin Li.
       BACKGROUND: Prostate cancer (PCa) is one of the most common cancer in men worldwide, while numerous scientific achievements have been made in research on Bone metastasis in prostate cancer (BMPCa) in recent years, a comprehensive and objective bibliometric analysis remains absent. This study aimed to elucidate the overall literature distribution and international frontier research direction of BMPCa.
    METHODS: A comprehensive bibliometric analysis was conducted on relevant literature on BMPCa extracted from the Web of Science database from 2007 to 2024 by Microsoft Office Excel, Biblioshiny, Scimago Graphica, VOSviewer and CiteSpace. 5512 papers related to BMPCa were extracted from the Web of Science Core Collection (WoSCC). The number of publications, countries, institutions, global collaborations, authors, journals, keywords, thematic trends, and cited references were then visualized. Finally, the research status and development direction were analyzed.
    RESULTS: This study included a total of 5512 papers on BMPCa from 2007 to 2024. There has been a steady increase in global publications ever year, peaking in 2021,and the overall publication shows a linear growth trend. USA had the highest number of publications and collaborative efforts, followed by China, England. The University of Texas MD Anderson Cancer Center published the most articles with 173, followed by University of Michigan with 120 and Memorial Sloan Kettering Cancer Center with 114. Prostate had the highest number of publications. The top three high-frequency keywords of occurrence were "prostate cancer", "bone metastasis" and "bone metastases", biblioshiny analysis of keywords shows that "arificial intelligence", "machine learning", and "ga-68"may represent the frontiers of this research area.
    CONCLUSION: The results showed that a linear growth trend in the number of publications, and the United States has made significant contributions to BMPCa both in quantity and in collaboration. International cooperation in BMPCa research needs to be further strengthened. We hope that more researchers and organizations can promote academic exchanges and strengthen cooperation to continue addressing the gaps of BMPCa. Further research should focus on the pathogenesis, early prevention, and the integration of individualized treatment with artificial intelligence, in order to improve patient survival and quality of life.
    Keywords:  Bibliometric analysis; Bone metastasis; Prostate cancer; Research trends; Visualization
    DOI:  https://doi.org/10.1007/s12672-026-04719-5
  7. Neurooncol Adv. 2026 Jan-Dec;8(1):8(1): vdag010
    Development and validation of the Home time and Overall survival after Metastatic spine tumor surgery Estimator (HOME score).
    Husain Shakil, Armaan K Malhotra, Christopher S Lozano, Vishwathsen Karthikeyan, Anne L Versteeg, Jetan H Badhiwala, Arjun Sahgal, Nicolas Dea, Michael G Fehlings, Alexander Kiss, Christopher D Witiw, Donald A Redelmeier, Jefferson R Wilson.
       Background: This study reports the development and validation of the Home time and Overall survival after Metastatic spine tumor surgery Estimator (HOME score).
    Methods: A population cohort study was conducted, including 2348 adults with spine metastases treated with surgery in the 2005 to 2020 Ontario Cancer registry. HOME score predictions were the likelihood of post-surgery home time of 3-months or less, and overall survival at 6 months, 1 year, and 1.5 years after surgery. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) for home time predictions, and the concordance index (C-index) for survival. Variable importance was quantified using standardized coefficients.
    Results: Mean age was 62.4 years (SD: 12.6) and the most common primary cancer was lung (N = 513, 21.9%). Patients treated between 2005 and 2018 were allocated to training, and those treated in 2019-2020 were used as a hold-out test cohort. The final model included 17 items for home time prediction, and 24 items for survival prediction including demographic, comorbid, cancer, and presentation features. Performance of the home time model (AUC: 0.70), and survival model (C-index 0.70, 6-month AUC: 0.73, 1-year AUC: 0.75, 1.5-year AUC: 0.76) was stable across training and testing. Primary cancer origin and history of congestive heart failure (CHF) ranked highest among features impacting outcome predictions.
    Conclusions: The HOME score (https://shakilh.shinyapps.io/home_app/) accurately predicts home time and survival for patients with spinal metastases undergoing surgery. Key factors influencing predictions were primary origin, and history of CHF. This represents a significant advancement to patient centered preoperative risk stratification.
    Keywords:  days at home; home time; prediction model; spinal metastasis; survival
    DOI:  https://doi.org/10.1093/noajnl/vdag010
  8. J Bone Oncol. 2026 Apr;57 100751
    Post-operative survival and use of systemic therapy in metastatic long-bone disease: 12 years of institutional experience.
    Tom M de Groot, Joris R H Hendriks, Michelle R Shimizu, Jens P Te Velde, Olivier Q Groot, Erik T Newman, Kevin Raskin, Job N Doornberg, Paul C Jutte, Santiago Lozano-Calderón, Joseph H Schwab.
       Background: Survival prediction in metastatic long-bone disease is essential for surgical decision-making, yet the performance of legacy prognostic models has declined in the era of immunotherapy and molecularly targeted agents. As these systemic therapies become routine, treatment patterns themselves may influence survival in ways not captured by earlier models. We, therefore, quantified preoperative systemic therapy use over the last decade and evaluated its association with postoperative overall survival in patients undergoing surgery for long-bone metastases.
    Methods: We conducted a retrospective cohort study of 975 consecutive adults who underwent surgery for long-bone metastases at two affiliated tertiary centers between January 2010 and June 2022. Preoperative systemic therapy was categorized into four groups: chemotherapy only, targeted therapy only, combined chemotherapy and targeted therapy, or neither. Postoperative was defined as time from surgery to death from any cause. We described temporal uptake of therapies by calendar year and assessed associations with postoperative survival using multivariable Cox regression adjusting for demographics, ECOG performance status, Katagiri primary tumor grouping, visceral/brain metastases, and laboratory variables. Adjusted survival over calendar time was summarized via marginal standardization at fixed horizons (1, 3, 12, and 24 months).
    Results: Use of targeted agents including checkpoint inhibitors rose markedly, from 2% in 2015 to 43% in 2022. In multivariable Cox models, preoperative chemotherapy alone was associated with worse survival versus no preoperative systemic therapy (HR 1.41, 95% CI 1.21-1.65; p < 0.01), as was combined chemotherapy plus targeted therapy (HR 1.24, 95% CI 1.05-1.47; p = 0.01). In contrast, targeted therapy alone before surgery was associated with better survival (HR 0.76, 95% CI 0.58-0.99; p = 0.04). Adjusted survival appeared to increase modestly across calendar years, but the pre-specified joint Wald test for the calendar year spline terms was not significant (p = 0.17), indicating a non-significant trend over time.
    Conclusion: This study found that preoperative systemic therapy patterns are strongly associated with post-operative survival in metastatic long-bone disease: targeted therapy alone correlates with improved survival whereas preoperative use of chemotherapy-alone or combined with targeted agents-was associated with worse survival. These findings support incorporating contemporary treatment exposure into prognostic models and suggest that model recalibration to the immunotherapy era may be warranted.
    Keywords:  Immunotherapy; Metastatic bone disease; Survival prediction; Targeted treatment
    DOI:  https://doi.org/10.1016/j.jbo.2026.100751
  9. Biology (Basel). 2026 Feb 21. pii: 364. [Epub ahead of print]15(4):
    The Neuro-Bone Axis in Metastatic Progression: Innervation, Neuro-Immune-Osteoclast Crosstalk, and Therapeutic Opportunities.
    Mohamad Bakir, Alhomam Dabaliz, Mohammed Raddaoui, Hala Fatash, Nourhan Elsaadany, Wael AlKattan, Khalid Said Mohammad.
      Bone metastases represent a major cause of morbidity in advanced cancers, yet the neural regulation of metastatic growth within bone remains largely unexplored. The skeletal system is richly innervated by sensory and sympathetic nerve fibers that influence bone remodeling, hematopoiesis, and immune surveillance. Emerging evidence suggests that disseminated tumor cells exploit these neural circuits to create a growth-permissive microenvironment. Tumor-secreted neurotrophic factors can induce nerve sprouting, while sympathetic activation via β-adrenergic receptors promotes osteoclastogenesis, immunosuppression, and tumor proliferation. Neuropeptides such as substance P and calcitonin gene-related peptide exert dual effects on bone cells and infiltrating immune populations, further shaping the metastatic niche. The interplay between neural signals, osteolytic activity, and immune modulation positions the neuro-bone axis as a critical but underappreciated driver of metastatic progression. In this review, we synthesize current evidence on the anatomy and function of bone innervation, tumor-induced neural remodeling, and neuro-immune-osteoclast interactions. We highlight preclinical and clinical data supporting neuromodulatory strategies, including β-blockers, neurotrophin inhibitors, and targeted nerve ablation, as potential adjuncts to standard bone metastasis therapies. Finally, we identify key knowledge gaps, including the need for spatial and functional mapping of nerve-tumor interfaces and for integrating neuroimaging into bone metastasis detection. By framing the neuro-bone axis as a therapeutic target, we aim to catalyze interdisciplinary research that bridges oncology, neuroscience, and bone biology, with the goal of disrupting neural support for metastatic growth.
    Keywords:  bone metastases; neuropeptides; neuro–bone axis; sympathetic nerves; tumor–nerve crosstalk; β-adrenergic signaling
    DOI:  https://doi.org/10.3390/biology15040364
  10. Adv Radiat Oncol. 2026 Jan;11(1): 101886
    Prospective Evaluation of Stereotactic Body Radiation Therapy for Reirradiation of Bone Metastases.
    Lubna Hammoudeh, Kee-Young Shin, Lauren Hertan, Monic Krishnan, Alex Spektor, Mai Anh Huynh, Chloe Fisher, Tracy Balboni.
       Purpose: Bone metastases are a common cause of morbidity among patients with cancer, and radiation therapy (RT) is efficacious for their palliation. However, symptomatic bone metastases can often occur in regions that have received prior RT, limiting doses that can be delivered safely. Stereotactic body radiation therapy (SBRT) enables the delivery of greater doses of RT to the tumor while minimizing reirradiation dose to critical organs at risk.
    Methods and Materials: In this prospective, multi-institutional phase 2 trial, 45 patients with bone metastasis in a previously irradiated region were treated with SBRT from February 2017 to November 2021. The primary endpoint was local control at 6 months post RT; secondary aims were rates of acute and chronic toxicity, time to local progression, local progression rate, progression-free survival, and overall survival.
    Results: The median age of participants was 62.6 years, and most were male (75.6%). The most common primary tumor types were as follows: prostate (13/45, 28.9%), lung (8/45, 17.8%), and renal cell (5/45, 11.1%). The majority received reirradiation to a spinal lesion (35/45, 77.7%). The most common dose prescriptions were 30 Gy in 5 fractions (24/45, 53.3%) and 35 Gy in 5 fractions (11/45, 24.4%). At 6 months, 42 of 45 treated sites were locally controlled, whereas 3 had progressed at a median of 3.6 months. The local progression-free rate was 89.9% at 2 years. Overall survival was 52% at 2 years. Acute toxicities occurred in 46.7%, most commonly fatigue, nausea, and pain flare; all were grade 1 or 2. In total, 8.9% of participants experienced chronic toxicities, including vertebral fracture and pain flare, all grade 1 or 2 with no myelopathies.
    Conclusions: This prospective study of SBRT for reirradiation of bone metastases demonstrated effective local control and reasonable rates of acute and chronic toxicities. Additional research is needed to further ascertain long-term efficacy and treatment-related toxicities.
    DOI:  https://doi.org/10.1016/j.adro.2025.101886
  11. J Clin Med. 2026 Feb 22. pii: 1653. [Epub ahead of print]15(4):
    Minimally Invasive Stabilization Versus Open Surgery for Spinal Metastases: A Retrospective Study Utilizing Propensity Score Matching and Weighting Sensitivity Analyses.
    Kamil Krystkiewicz, Aleksander Kowal, Agata Krajniak, Łukasz Kuncman, Marcin Tosik.
      Background: Minimally invasive spinal stabilization (MISS) is increasingly used in metastatic spine surgery, but comparative evidence vs. open posterior stabilization (OPEN) remains limited. We compared perioperative outcomes, focusing on wound-related morbidity. Methods: This retrospective single-center cohort included 71 patients undergoing posterior stabilization for spinal metastases (MISS n = 45; OPEN n = 26). Wound-healing disorder was the primary endpoint. Groups were compared using nonparametric exact tests; adjusted and propensity score analyses were performed to assess robustness. Results: Baseline SINS, operated segment, and instrumented levels were comparable. BMI was higher in MISS (25.8 [24.0-29.7] vs. 22.1 [20.0-24.9] kg/m2; p = 0.001), and urgent admissions were more frequent in OPEN (42.3% vs. 11.1%; p = 0.006). Wound-healing disorders occurred in 6.7% (3/45) of the MISS group vs. 30.8% (8/26) of the OPEN group. (p = 0.014; crude RR 4.62, 95% CI 1.34-15.88). After adjustment for admission type, BMI, and ECOG (n = 65), the association was attenuated (adjusted RR 1.80, 95% CI 0.24-13.68; p = 0.572). SSI occurred in 1/45 (2.2%) MISS vs. 5/26 (19.2%) OPEN (p = 0.022). Estimated blood loss was similar between groups (MISS: 500 [350-800] vs. OPEN: 600 [500-700] mL; p = 0.357). The median length of stay was shorter in the MISS group, though this did not reach statistical significance. In trimmed IPTW (64 complete cases), OPEN remained associated with higher weighted risk (RR 1.91, 95% CI 0.42-8.65; p = 0.403). Conclusions: OPEN surgery was associated with higher unadjusted wound-related morbidity than MISS, while blood loss did not differ between approaches. Length of stay tended to be shorter after MISS, but analyses were underpowered.
    Keywords:  metastatic spine disease; minimally invasive spine surgery; surgery complications; surgical site infection
    DOI:  https://doi.org/10.3390/jcm15041653
  12. Glob Health Med. 2026 Feb 28. 8(1): 53-58
    Prognostic comparison between osteoblastic and osteolytic metastases in prostate cancer.
    Akihiro Ono, Kazuki Akiyama, Ryohei Nishimoto, Ryo Amakawa, Yasushi Inoue, Tadashi Yoshimatsu, Yoshiyuki Shiga, Masashi Kusakabe, Haruyasu Yamada, Satoru Taguchi, Haruki Kume, Masaki Nakamura.
      Over 80% of patients develop bone metastases in the advanced stages of prostate cancer, resulting in a poor prognosis. To date, no study has explored the relationship between the type of bone metastasis and patient outcomes. The objective of this study was to compare the clinical features and prognoses of patients with osteoblastic and osteolytic bone metastases. Among the 63 patients diagnosed with bone metastases from prostate cancer at our institution between May 2011 and September 2023, 51 were classified as having osteoblastic metastases and 12 as having osteolytic metastases based on imaging findings. Overall survival was analyzed using Kaplan-Meier survival curves, and differences between groups were assessed using the log-rank test. Clinical parameters were compared using the Mann-Whitney U test. Univariate and multivariate Cox proportional hazards analyses were conducted to identify the prognostic factors. No significant differences were observed between the osteoblastic and osteolytic groups in terms of clinical or laboratory parameters, except for a higher platelet count in the osteoblastic group (p = 0.0181). The five-year overall survival rate was significantly higher in the osteoblastic group than in the osteolytic group (49.5% vs. 30.0%, p = 0.0437), with median survival times of 59 months and 38.5 months, respectively. In both univariate and multivariate Cox analyses, the type of bone metastasis was the only factor significantly associated with increased hazard ratios. Patients with osteolytic bone metastases from prostate cancer have a markedly lower five-year overall survival than those with osteoblastic metastases.
    Keywords:  bone metastases; osteoblastic; osteolytic; prostate cancer
    DOI:  https://doi.org/10.35772/ghm.2025.01131
  13. BMC Med. 2026 Feb 21.
    The influence of immunohistochemistry-based subtypes on overall survival in breast cancer spine metastases: a systematic review and meta-analysis.
    Fon-Yih Tsuang, Yun-Heng Li, Ting-Li Shen, Chiun-Sheng Huang, Chung Liang Chai.
       BACKGROUND: Breast cancer spinal metastases present a growing clinical challenge, with survival outcomes varying significantly by immunohistochemistry-based subtype. Current prognostic models often overlook subtype-specific differences, potentially leading to suboptimal treatment decisions. This study aimed to establish the first comprehensive subtype-specific survival benchmarks for spinal metastases and to evaluate temporal trends in survival.
    METHODS: We conducted a systematic review and meta-analysis of survival outcomes following a predefined protocol (PROSPERO CRD42024580279). Eligible studies reported overall survival (OS) in patients with breast cancer spinal metastases, stratified by immunohistochemistry-based subtype: hormone receptor (HR +), human epidermal growth factor receptor 2-enriched (HER2 +), and triple-negative breast cancer (TNBC). Survival data were extracted from published figures with a digitizer program and then processed in R. The median OS was analyzed through pooled survival curves with 95% confidence intervals, compared via log-rank tests. To evaluate temporal trends, we performed era-stratified analyses (pre-2000, 2000-2019, post-2020) using chronological partitioning of study enrollment periods.
    RESULTS: After screening 2,348 records, we identified seven eligible cohorts comprising 672 patients. Analysis revealed significant survival differences among subtypes (log-rank p < 0.0001), with median OS of 28.9 months (95% CI 26.0-35.6; n = 347) for HR + , 43.7 months (31.9-48.7; n = 244) for HER2 + , and 10.7 months (8.9-19.2; n = 81) for TNBC (very low certainty of evidence for all outcomes). Temporal analysis of 4464 patients from 61 studies demonstrated significant survival improvements post-2020 (log-rank p < 0.0001).
    CONCLUSIONS: This study establishes the first real-world unadjusted survival reference for subtypes in breast cancer spinal metastases, suggesting a potential survival advantage of HER2 + /HR + over HER2 + /HR - tumors. These findings underscore the essential role of subtyping in refining prognostic assessment for spinal metastases. Our findings demonstrate a temporal improvement in survival and highlight the persistent need for contemporary data in this rapidly evolving clinical landscape.
    TRIAL REGISTRATION: PROSPERO CRD42024580279.
    Keywords:  Breast cancer; Metastasis; Spine; Subtype; Survival analysis
    DOI:  https://doi.org/10.1186/s12916-026-04715-0
  14. Cancers (Basel). 2026 Feb 07. pii: 547. [Epub ahead of print]18(4):
    The Use of Radiotherapy in Leptomeningeal Carcinomatosis: A Systematic Review and Random-Effects Proportions Meta-Analysis.
    Pamela Ochoa-Lantigua, Mauricio Moreno-Bejarano, Cayetana Guarderas-Arias, José Bueno-Miño, Jose E Leon-Rojas.
      Objective: Leptomeningeal carcinomatosis (LMC) is a rare but devastating complication of advanced cancer, particularly in patients with breast and lung malignancies. This systematic review provides a descriptive synthesis of radiotherapy approaches used in patients with leptomeningeal metastases, with a quantitative proportions meta-analysis focused on treatment-related toxicity. Materials and methods: A systematic search was conducted in PubMed, Scopus, and the virtual health library (BVS) databases following PRISMA 2020 guidelines. Studies including patients diagnosed with LMC and treated with RT were selected. Outcomes included overall survival (OS), adverse events (toxicities), and functional response. Results: A total of 39 studies comprising 2822 patients were included; the most frequent primary tumors were lung (n = 1337) and breast (n = 990) cancers. The mean time from cancer diagnosis to LMC was 22.4 months. Radiotherapy regimens included whole-brain radiotherapy (WBRT, n = 1054), craniospinal irradiation (CSI, n = 148), and focal RT (n = 27); RT was administered alone or in combination with systemic treatments. Toxicity was reported in 462 patients, primarily fatigue (n = 115), nausea/vomiting (n = 72), and hematological events (notably in CSI). The pooled toxicity prevalence was 50.8% (95% CI, 26.1-75.4; I2 = 96.1; p < 0.0001) for all RT modalities, and 31.6% (95%CI, 15.0-50.8; I2 = 90.7; p < 0.0001) for WBRT. CSI toxicity estimates were based on a limited number of studies and did not reach statistical significance, and should therefore be interpreted as exploratory. Mean OS from LMC diagnosis was 18.2 weeks; OS by treatment was 21.5 weeks and 20.3 weeks, for RT by itself and combined, respectively. Conclusions: LMC predominantly affects patients with advanced-stage lung and breast cancers and presents with variable clinical timelines and functional impairment. Radiotherapy represents a frequently utilized and clinically important component of the palliative management of leptomeningeal disease, particularly for symptom control and neurological stabilization, rather than a treatment associated with superior survival outcomes. Prognosis is more closely linked to patient-specific factors than to treatment type. Radiotherapy toxicity is prevalent; however, most are categorized as type 1 toxicities with insignificant to little damaging effects on patients.
    Keywords:  craniospinal irradiation; leptomeningeal carcinomatosis; radiotherapy; survival; toxicity; whole-brain radiotherapy
    DOI:  https://doi.org/10.3390/cancers18040547
  15. J Pain Symptom Manage. 2026 Feb 24. pii: S0885-3924(26)00080-1. [Epub ahead of print]
    Multimodal Management of Metastatic Brachial Plexopathy in Breast Cancer.
    Ruoxi Cao, Deepali Bang, Mothi Babu Ramalingam.
      Metastatic brachial plexopathy (MBP) is a severe, late complication of breast cancer marked by intractable pain, sensorimotor deficits, lymphedema, and profound functional loss. This Palliative Care Rounds report details the clinical course of a 47-year-old woman diagnosed with MBP four years after her initial breast cancer presentation, who survived a further 56 months. The case illustrates the diagnostic challenges, prolonged symptom trajectory, and complex rehabilitative and palliative needs associated with MBP in the context of extended survival. Meaningful symptom relief was achieved through the proactive integration of disease-directed therapy, pharmacologic and interventional analgesia, structured rehabilitation, and supportive care within a multidisciplinary framework. This case underscores that, despite the limited potential for neurological recovery, a coordinated, multimodal strategy initiated early can alleviate suffering, preserve function, and optimize quality of life throughout the disease course.
    Keywords:  Breast cancer; Metastatic brachial plexopathy; Multidisciplinary care; Pain management; Palliative care; Rehabilitation
    DOI:  https://doi.org/10.1016/j.jpainsymman.2026.02.015
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