bims-rebome 2026-04-05 papers

Neurochirurgie. 2026 Mar 26. pii: S0028-3770(26)00038-X. [Epub ahead of print]72(3): 101804

Imaging of spinal metastases: modality performance, complications, and differential diagnosis.

Quentin Beaufort, Valentin Lefevre, Thibault Carsuzaa.

Spinal metastases are the most common malignant involvement of the axial skeleton and a major source of cancer-related morbidity. Imaging is central throughout patient management, from initial detection and differential diagnosis of vertebral lesions to staging, treatment planning, and early identification of complications. Magnetic resonance imaging (MRI) is the reference modality owing to its high sensitivity for marrow infiltration and its ability to assess epidural extension and spinal cord compression in a single examination. Computed tomography (CT) remains essential for evaluating cortical destruction and mechanical instability, particularly within the Spinal Instability Neoplastic Score (SINS) framework, although it is less sensitive for early marrow disease. Nuclear medicine and positron emission tomography (PET) techniques provide complementary whole-body assessment, with performance depending on tumour biology. While bone scintigraphy has variable specificity, SPECT improves lesion localisation. 18F-FDG PET/CT sensitivity varies according to tumour phenotype, whereas 18F-NaF PET/CT demonstrates high sensitivity for osteoblastic metastases. In prostate cancer, PSMA PET/CT offers excellent staging accuracy. Complications, including pathological vertebral compression fractures and metastatic epidural spinal cord compression, are oncologic emergencies requiring prompt imaging. Current guidelines recommend urgent MRI, ideally within 24 h. Neural compromise is graded using the Bilsky ESCC scale, and instability is assessed with SINS. Emerging MRI-based morphometric parameters remain investigational. Differential diagnosis relies primarily on T1 marrow signal assessment, integrated with CT features and advanced MRI techniques. Optimal imaging strategies require integrating modality performance with tumour biology and clinical context to guide multidisciplinary decision-making.

Keywords: Computed tomography; Magnetic resonance imaging; Metastatic epidural spinal cord compression; Nuclear imaging; Pathological vertebral compression fracture; Spine metastases

DOI: https://doi.org/10.1016/j.neuchi.2026.101804

Cardiovasc Intervent Radiol. 2026 Mar 31.

Radiofrequency Ablation for the Treatment of Bone Metastases: Results of the SPARTA Study.

Mario Muto, Francesco Amato, Matteo Bellini, Luigi Manfrè, Emanuele Piras, Stefano Marcia, Stefano Marini, Tiziana Iannaccone, Francesco Lucarelli.

PURPOSE: This study evaluated the safety and efficacy of radiofrequency ablation for the palliative treatment of bone metastases in the SPARTA study.
MATERIALS AND METHODS: The SPINERY® Radiofrequency Ablation (RFA) System Premarket Study (SPARTA) is a prospective, single-arm, multicenter clinical trial in Italy. Patients with metastatic bone tumors underwent RFA using SPINERY® between July 2022 and December 2023. The Brief Pain Inventory (BPI) for pain severity and the EQ-5D-5L questionnaire for quality of life (QoL) were assessed at baseline and at 1, 3, and 12 months post-procedure. Primary endpoints were achievement of a ≥ 2-point reduction in the 3-month BPI score, and completion of the procedure without device-related adverse events.
RESULTS: Among 52 enrolled patients (mean age 63.8 ± 11.2, 61.5% [32/52] female), RFA was performed in 51, followed by vertebroplasty in 78.4% (40/51), with 100% technical success and no device-related adverse events. Compared to baseline, mean BPI scores improved at 1 month (Δ- 3.3 ± 2.7, p < 0.001), 3 months (Δ- 4.2 ± 2.5, p < 0.001), and 12 months (Δ- 5.4 ± 2.7, p < 0.001). Mean EQ-5D-5L scores also improved at 1 month (Δ15.7 ± 17.6, p < 0.001), 3 months (Δ22.7 ± 17.1, p < 0.001), and 12 months (Δ33.3 ± 20.7, p < 0.001). There were 13 (25.5%) adverse events and 13 (25.5%) deaths that were disease-related, not device-related.
CONCLUSION: The SPARTA study demonstrates rapid and substantial pain relief within 1 month and improved QOL, supporting radiofrequency ablation, in combination with vertebroplasty when indicated, as a minimally invasive treatment for pain associated with bone metastases. LEVEL OF EVIDENCE 3: Prospective cohort study.

Keywords: Bone metastasis; Brief pain inventory; SPINERY® radiofrequency ablation

DOI: https://doi.org/10.1007/s00270-026-04395-6

J Craniovertebr Junction Spine. 2026 Mar-Apr;17(2):17(2): 151-157

The impact of prior radiation or chemotherapy on surgical outcomes in the treatment of spine metastases.

Alec Giakas, Joydeep Baidya, Jonathan Dalton, William A Green, Mitchell Ng, Teeto Ezeonu, Rajkishen Narayanan, Yunsoo A Lee, Perry Goodman, Eleanor Jenkins, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler.

Study Design: This was a retrospective cohort study.
Objective: The objective of this study was to evaluate the impact of prior chemotherapy and/or radiation on outcomes among patients undergoing surgery for spinal metastases.
Summary of Background Data: Spinal metastases are associated with significant pain, functional decline, and poor prognosis. Prior chemotherapy and radiation are common and impose a substantial morbidity, but their influence on surgical outcomes remains poorly defined.
Materials and Methods: A retrospective chart review of adult patients who underwent surgery for spine metastasis was conducted at a single institution (2017-2022). Demographic, surgical, and oncologic data were collected via manual chart review. Patients were stratified based on a history of chemotherapy and/or radiation. Outcomes included estimated blood loss, length of stay (LOS), rate and number of inpatient complications, 30-day emergency department visits, 90-day readmissions, 1-year reoperation, and 1- and 5-year mortality.
Results: Forty-four patients were included (23 received prior chemotherapy/radiation). The most common surgical indication was multiple myeloma in patients with prior therapy (17.39%) and lung metastases in patients without prior therapy (28.57%). Seventeen patients (80.95%) without prior therapy received chemotherapy/radiation postoperatively. Patients with prior therapy experienced shorter LOS (9.78 ± 7.40 vs. 20.0 ± 16.0 days; P = 0.015), lower complication rate (39.1% vs. 76.2%; P = 0.030), and fewer complications per patient (0.74 ± 1.51 vs. 2.29 ± 1.82; P = 0.001). All other outcomes were similar between the groups.
Conclusions: Prior therapy was associated with reduced LOS and inpatient morbidity. These findings may reflect differences in tumor biology or oncologic patient heterogeneity. Primary tumor types were poorly isolated, and the sample size limited definitive conclusions, further underscoring the need for robust future investigation.

Keywords: Cancer; chemotherapy; decompression; metastasis; mortality; radiation; surgical outcomes; tumor

DOI: https://doi.org/10.4103/jcvjs.jcvjs_175_25

Oncol Lett. 2026 May;31(5): 182

Predictive performance of image processing techniques in the diagnosis of bone metastasis: A meta-analysis of a confusion matrix.

Yupeng Hu, Wen Liao, Ying Er, Qifeng Tao.

Bone metastasis, a common cause of disability, markedly affects prognosis and life expectancy, and is usually diagnosed through radiographic imaging. An early and accurate diagnosis of bone metastasis is critical in order to optimize therapeutic strategies and palliative care. Computer-based image processing techniques have proved promising to improve diagnostic efficiency. The present systematic review and meta-analysis aimed to evaluate the efficacy of the diagnostic performance metrics of computational image processing techniques in patients with lung cancer and bone metastasis. Following the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines, a comprehensive literature search was conducted across different databases between January 2010 and December 2024. Studies assessing computational image-processing techniques in patients with lung cancer and bone metastasis were included. Confusion matrix parameters were extracted and the bivariate Reitsma model was applied to estimate the pooled diagnostic performance. Heterogeneity and inconsistency (variance of components and I2 values), and risk of bias (quality assessment of diagnostic accuracy studies-2 tool) were appraised for the included studies. Overall, 6 studies were included in the meta-analysis. A high overall diagnostic accuracy (area under the summary receiver operating characteristic curve, 0.931), a pooled sensitivity of 0.86 and a specificity of 0.88 were achieved. Favorable positive and negative likelihood ratios (7.22 and 0.165, respectively) indicated the strong discriminatory ability of the model. Despite some heterogeneity, stable high negative predictive values confirmed the reliability of ruling out non-metastasis when screening for metastasis. Computer-based image processing techniques demonstrated excellent diagnostic accuracy for bone metastasis in patients with lung cancer. Further studies should focus on investigating a unique standardized diagnostic tool that can be applied in a clinical setting to improve patient management.

Keywords: bone metastasis; confusion matrix; image processing; lung cancer

DOI: https://doi.org/10.3892/ol.2026.15537

Clin Genitourin Cancer. 2026 Mar 11. pii: S1558-7673(26)00034-0. [Epub ahead of print] 102534

Clinical Characteristics and Predictive Factors of Symptomatic Skeletal Events in Patients With Metastatic Castration-Sensitive Prostate Cancer Treated With Denosumab.

JIKEI-YAYOI Collaborative Group

BACKGROUND: Skeletal-related events are significant complications in prostate cancer patients with bone metastases. While bone-modifying agents are established in metastatic castration-resistant prostate cancer (mCRPC), their role in metastatic castration-sensitive prostate cancer (mCSPC) remains unclear. This study characterized symptomatic skeletal events (SSEs) and identified factors predicting their onset in mCSPC patients treated with denosumab.
METHODS: We retrospectively analyzed 318 mCSPC patients with bone metastases who received denosumab between 2015 and 2024. The primary endpoint was the probability of SSE occurrence, defined as symptomatic pathologic fracture, spinal cord compression, symptoms requiring orthopedic surgery, or external beam radiotherapy (EBRT) due to bone complications. Predictive factors were assessed using multivariate Cox regression and logistic regression analyses. The optimal serum alkaline phosphatase (ALP) cutoff for predicting SSEs was determined with receiver operating characteristic (ROC) analysis.
RESULTS: Over a median follow-up of 25 months, 32 patients (10.1%) developed SSEs, most commonly symptoms requiring EBRT (7.9%). The 3-year probability of SSE occurrence was 15.4%. Multivariate analysis identified elevated ALP as an independent predictor of SSEs (hazard ratio per 50-U increase: 1.03; 95% confidence interval, 1.01-1.04; P = .002). The ROC-derived ALP cutoff of 127.75 U/L was significantly associated with increased SSE risk. The most common reasons for denosumab discontinuation were death (19.0%) and osteonecrosis of the jaw (19.0%).
CONCLUSIONS: In this real-world mCSPC cohort, SSEs occurred in ∼15% of patients within 3 years of denosumab initiation. Elevated ALP was a significant predictor, supporting the need for individualized bone management strategies in mCSPC.

Keywords: Bone-modifying agents; Cancer management; JIKEI-YAYOI study; Risk factor

DOI: https://doi.org/10.1016/j.clgc.2026.102534