bims-rebome 2026-03-08 papers

BMJ Support Palliat Care. 2026 Mar 02. pii: spcare-2025-006054. [Epub ahead of print]

Preoperative radiotherapy for appendicular bone metastases: outcomes.

Jane B Pearce, Prasamsa Pandey, Comron Hassanzadeh, Benjamin D Smith, Aileen Chen, Alysia Kemp, Justin Bird, Shalin Shreyaskumar Patel, Robert Satcher, Patrick P Lin, Lauren E Colbert, Melissa Mitchell, David Grosshans.

OBJECTIVES: Bone metastases are common in advanced cancers. In patients with impending pathologic fractures, prophylactic fixation can improve quality of life. Postoperative radiotherapy (RT) is the standard of care for bone metastases; however, preoperative RT may be beneficial in some patients. We evaluated outcomes in patients treated with preoperative RT for bone metastases.
METHODS: We performed a retrospective review of 10 patients with bone metastases treated with preoperative RT. Descriptive statistics were used to characterise the cohort, and the Kaplan-Meier method was used to estimate time to subsequent palliative RT treatment and overall survival.
RESULTS: 10 patients were included in the analysis. Preoperative RT was used for various reasons, including for continuation of systemic therapy (20%), to reduce the RT field (20%) and due to medical comorbidities delaying surgery (20%). The median time from completion of RT to surgery was 13 days (IQR 7-21). The majority of patients (90%) had no postoperative complications. No patients had radiographic evidence of local disease recurrence at a median of 13 months.
CONCLUSIONS: Patients treated with preoperative RT do well with minimal operative complications and improvement in reported pain. A randomised clinical trial is warranted to compare outcomes for preoperative and postoperative RT for palliation of bone metastasis requiring orthopaedic intervention.

Keywords: Bone; Pain; Palliative Care

DOI: https://doi.org/10.1136/spcare-2025-006054

Acta Orthop Belg. 2025 Sep;91(3): 387-398

Survival at Stake: Surgical Decision-Making in Metastatic Femoral.

A Yucesan, Y Arikan, S Toy, V Karaduman, D Özer.

Pathological femoral fractures resulting from primary or metastatic tumors represent a complex clinical challenge for orthopedic surgeons, often requiring individualized treatment strategies. This retrospective study aimed to evaluate and compare the outcomes of different surgical approaches used in the management of pathological femoral fractures secondary to metastatic disease. A total of 46 patients (52 femoral fractures) who underwent surgical treatment between 2020 and 2023 were included in the study. Data collected encompassed demographic characteristics, tumor histology, surgical techniques employed, and clinical outcomes. Statistical analysis was conducted using appropriate parametric and non-parametric tests, depending on data distribution. Of the patients included, 51% underwent tumor resection followed by endoprosthetic reconstruction, 40% were treated with intramedullary nailing, and 9.4% underwent plate osteosynthesis. The highest postoperative mortality rate was observed among patients with lung cancer metastases. Blood transfusions were necessary in 66% of cases. The overall mean survival time following surgery was 4.5 months, with significant variation according to tumor type and metastatic burden. The findings of this study underscore the importance of a multidisciplinary approach in the surgical management of pathological femoral fractures caused by metastatic tumors. Surgical interventions such as intramedullary nailing, plate fixation, and endoprosthetic reconstruction can effectively restore mechanical stability and contribute to improved patient quality of life. Selection of the optimal surgical technique should be guided by tumor histopathology, anatomical location and extent of bone involvement, number of metastatic lesions, and overall patient prognosis. Timely and appropriate surgical intervention remains critical to minimizing complications and enhancing survival outcomes in this patient population.

DOI: https://doi.org/10.52628/91.3.14701

Br J Nurs. 2026 Mar 05. 35(5): S8-S13

Safety of extending dosing intervals of denosumab in adults with solid cancer and bone metastasis: a review.

Emma Paul.

BACKGROUND: Denosumab is approved to be given every 4 weeks for the prevention of skeletal-related events in adults with solid cancer and bone metastasis. Research has suggested that it is safe to be given every 12 weeks, improving patients' quality of life and alleviating capacity and financial issues for healthcare providers; a definitive answer is required to change policy.
AIMS: This study aimed to assess the safety of extending dosing intervals of denosumab in adults with solid cancer and bone metastasis.
METHODS: A rigorous systematic review was conducted, using multiple databases and grey literature. Language was restricted to English. Included studies were critically appraised and assessed for potential bias.
FINDINGS: Three studies were included, with a total of 950 participants: two randomised controlled trials (RCTs) and one retrospective cohort study. A narrative analysis found no significant difference between the 4-weekly and 12-weekly regimens in terms of safety, apart from a higher rate of hospitalisations associated with the shorter interval.
CONCLUSION: Further RCTs with robust methodology are required to confirm the findings of this review. A large non-inferiority phase III trial is in progress, which should address this.

Keywords: Bone; Cancer; Denosumab; Metastases; Regimen; Safety

DOI: https://doi.org/10.12968/bjon.2025.0082

Jpn J Clin Oncol. 2026 Mar 01. pii: hyag034. [Epub ahead of print]

Cost-effectiveness analysis of a bone metastasis cancer board for skeletal-related events of breast cancer.

Satoru Yanagaki, Shinichirou Yoshida, Sota Oguro, Shin Hitachi, Hiroshi Tada, Yojiro Ishikawa, Munenori Watanuki, Jun Iwatsu, Hirotaka Kurata, Toshimi Aizawa, Takayuki Yamada, Kei Takase.

OBJECTIVE: To evaluate the cost-effectiveness of treatment strategies for patients with breast cancer and bone metastasis (BM) developed with and without the involvement of a multidisciplinary BM cancer board.
METHODS: In this single-center retrospective cohort study, we used previously published data and the data obtained from consecutive patients diagnosed with breast cancer and BM referred to the Tohoku University Hospital between July 2021 and May 2025. We developed a model combining a decision tree for the diagnosis and treatment phases of breast cancer and BM and a Markov model for long-term follow-up to evaluate the cost-effectiveness from a healthcare payer's perspective. The model included three health states: alive without skeletal-related event (SRE), alive with SRE, and death, with 1-month cycles. Effectiveness was measured in quality-adjusted life years. Deterministic and probabilistic sensitivity analyses were also performed.
RESULTS: The strategy developed using BM cancer board inputs demonstrated superior cost-effectiveness; the incremental cost-effectiveness ratio was below the Japanese willingness-to-pay threshold of 5 million Japanese yen per quality-adjusted life year. Sensitivity analysis confirmed robustness of these results, with a tornado diagram identifying the key influential parameter: the probability of treatable BM in the BM cancer board strategy. In the probabilistic sensitivity analysis with 10 000 Monte Carlo simulations, more than half of the estimates fell below the willingness-to-pay threshold.
CONCLUSIONS: The treatment strategy developed by involving a BM cancer board is more cost-effective than that developed without involving such a board, justifying healthcare resource allocation for implementation of this board.

Keywords: bone metastasis; cancer board; cost-effectiveness analysis; skeletal-related event

DOI: https://doi.org/10.1093/jjco/hyag034

JCO Oncol Pract. 2026 Mar 02. OP2500556

Modern Advancements in Radiation Oncology: What Every Oncologist Should Know.

Rimsha J Afzal, Christina C Huang, Kaitlyn Lapen, Fumiko Chino.

Radiation oncology has undergone a profound transformation over the past 50 years, evolving from broad techniques to highly conformal, precision-guided treatments. This review synthesizes key advancements in the field, first from technological innovations allowing the provision of precisely aligned and uniquely tailored radiation, customized to patient anatomy (such as intensity modulated radiation therapy, stereotactic body radiation therapy, and MR Linac) to emerging applications of particle beams, radiopharmaceuticals, and adaptive planning platforms. These advances have facilitated more accurate treatments and decreased side effect burden. The role of radiation therapy has also expanded in the management of metastatic disease beyond simply palliation, with ablative techniques leading to improved progression-free survival in oligometastatic settings. The combination of radiation with immunotherapy can introduce synergistic effects and is reshaping treatment paradigms across disease sites. However, widespread adoption of radiation innovation faces challenges, including rising financial toxicity, geographic disparities in access, and administrative burdens of prior authorization. As radiation oncology enters a new era, oncologists across specialties must remain informed about the evolving factors that affect timely radiation delivery.

DOI: https://doi.org/10.1200/OP-25-00556