bims-rebome Biomed News
on Management of bone metastases
Issue of 2026–04–12
six papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata
  1. Bone Metastasis Distribution Matters: Prognostic Effect of the Axial-to-Peripheral Ratio in Metastatic Hormone-Sensitive Prostate Cancer.
  2. Elective Surgical Care Pathways Are Associated With Lower Fracture Rates at Presentation and Contribute to Superior Clinical Outcomes in Metastatic Bone Disease.
  3. Outcomes of surgical treatments for sacral metastases.
  4. Safety of Perioperative Immunotherapy Use on Wound Healing After Surgery for Spinal Metastases.
  5. Using the Systemic Inflammatory Response Index and the Prognostic Nutritional Index in Predicting Subsequent Bone Metastases in Patients with Non-Small Cell Lung Cancer.
  6. Chinese expert consensus on magnetic resonance-guided focused ultrasound surgery for painful bone metastases.
  1. Prostate. 2026 Apr 08.
    Bone Metastasis Distribution Matters: Prognostic Effect of the Axial-to-Peripheral Ratio in Metastatic Hormone-Sensitive Prostate Cancer.
    Ali Fuat Gürbüz, Murat Araz, Hacer Demir, Halil Göksel Güzel, Banu Öztürk, Berrak Mermit Erçek, Müslih Ürün, Semiha Urvay, İsmail Beypinar, Aziz Kurtuluş.
       BACKGROUND: Bone metastases represent the dominant pattern of spread in metastatic hormone-sensitive prostate cancer (mHSPC). Current prognostic classifications mainly rely on metastatic burden defined by lesion number or volume, while the prognostic significance of anatomical distribution within the skeleton remains insufficiently explored. This study aimed to investigate the prognostic impact of axial and peripheral bone metastasis patterns and to evaluate the clinical relevance of the axial-to-peripheral bone metastasis ratio in mHSPC.
    METHODS: This multicenter retrospective study included 209 patients with radiologically confirmed bone-metastatic mHSPC treated between January 2018 and November 2025. Bone metastases were classified as axial, peripheral, or combined according to anatomical location using conventional imaging and PSMA PET/CT. Metastatic burden was quantified separately for axial and peripheral compartments, and an axial-to-peripheral bone metastasis ratio was calculated.
    RESULTS: Axial skeletal involvement was present in 94.7% of patients, while 81.3% exhibited peripheral metastases. Patients with combined axial and peripheral involvement demonstrated inferior survival compared with those with isolated axial disease. The axial-to-peripheral metastasis ratio emerged as a significant prognostic factor (log-rank p = 0.004). Patients with a balanced distribution (ratio = 1) had markedly worse survival (median OS 15.0 months) compared with those with axial-predominant disease (ratio = 2; median OS 40.0 months). Increasing axial metastatic burden was associated with a stepwise increase in mortality risk.
    CONCLUSIONS: The axial-to-peripheral bone metastasis ratio represents a novel and clinically applicable prognostic marker in mHSPC.
    Keywords:  PSMA PET/CT; axial skeleton; axial‐to‐peripheral ratio; bone metastasis; metastatic hormone‐sensitive prostate cancer; peripheral skeleton
    DOI:  https://doi.org/10.1002/pros.70176
  2. J Surg Oncol. 2026 Apr 09.
    Elective Surgical Care Pathways Are Associated With Lower Fracture Rates at Presentation and Contribute to Superior Clinical Outcomes in Metastatic Bone Disease.
    Annalise G Abbott, Joseph K Kendal, Benjamin Wajda, Golpira Elmi Assadzadeh, Shannon K T Puloski, Michael J Monument.
       BACKGROUND AND OBJECTIVES: Metastatic bone disease (MBD) often necessitates orthopaedic surgical intervention, which occurs through either emergent or elective care pathways. This study compared post-operative outcomes between patients undergoing elective versus emergent surgery for MBD involving the pelvis and appendicular skeleton.
    METHODS: We performed a retrospective, multicenter, propensity-matched cohort study of patients who underwent surgery for MBD. Emergent surgery was defined as an unplanned admission followed by unscheduled surgery, while elective surgery referred to cases with an outpatient orthopaedic consultation and scheduled procedure. Primary outcomes were overall survival (OS) from the time of surgery, hospital length of stay (LOS), and 30-day readmission.
    RESULTS: Following propensity matching, 296 patients were included with 148 in each group. OS was significantly shorter in the emergent group (5.0 months 95%CI: 3.0-6.0 vs. 16.9 months 95%CI: 11.1-21.2) [p < 0.001]. LOS was significantly longer in the emergent group (13 days, 95%CI: 6-28 vs. 6 days, 95%CI: 3-10 days) [p < 0.001]. There was a significantly greater rate of readmission in the emergent group (12.2% 95%CI: 10.3-17.6 vs. 6.1% 95%CI: 3.5-10.2) [p = 0.004].
    CONCLUSION: Elective surgery for MBD was associated with significantly superior clinical outcomes. Interventions that reduce the need for emergent surgery could markedly improve outcomes in this population.
    Keywords:  cancer; health services; metastatic bone disease; pathologic fracture
    DOI:  https://doi.org/10.1002/jso.70253
  3. Surg Neurol Int. 2026 ;17 151
    Outcomes of surgical treatments for sacral metastases.
    Takaki Shimizua, Richard Lander, Mina Botros, Mark Lawlor, Mark Ehioghae, Jonathan P Japa, Kevin Yoon, Addisu Mesfin.
       Background: Sacral metastases can cause severe pain, neurologic deficits, and sacroiliac instability, leading to substantial functional impairment. Although surgery is used for symptom palliation, patient-reported outcomes (PROs) following minimally invasive spinopelvic fixation remain poorly characterized.
    Methods: We retrospectively reviewed 10 patients (median age, 63 years) who underwent surgery for sacral metastases between 2015 and 2022. Procedures included posterior decompression alone or posterior decompression with minimally invasive spinopelvic fixation for sacroiliac instability. Eastern Cooperative Oncology Group (ECOG) performance status and PRO measurement information system (PROMIS) pain interference (PI), physical function (PF), and Depression scores were collected preoperatively and at 3 months postoperatively. Overall survival was estimated using Kaplan-Meier analysis.
    Results: Four patients underwent posterior decompression alone, and six underwent decompression with minimally invasive spinopelvic fixation. Mean ECOG improved from 2.5 preoperatively to 1.6 at 3 months (P = 0.06). PROMIS PI improved by a mean of -8.7 (P < 0.01), exceeding the minimum clinically important difference, while PF improved by 4.5 (P = 0.03). Depression scores improved by -3.5 but were not statistically significant (P = 0.20). In the instrumented subgroup, PROMIS PI improved by -8.5 (P = 0.028), with trends toward improved ECOG and PF. Three surgery-related complications occurred, with no instrumentation failures. Median survival was 9 months, with 6-, 12-, and 24-month survival rates of 80%, 70%, and 35%, respectively.
    Conclusion: Surgery for sacral metastases provides clinically meaningful pain relief and short-term functional improvement. Minimally invasive spinopelvic fixation is a feasible option for patients with sacroiliac instability and supports durable symptom palliation.
    Keywords:  Minimally invasive surgery; Patient-reported outcome; Sacral metastasis; Surgery
    DOI:  https://doi.org/10.25259/SNI_12_2026
  4. Neurosurgery. 2026 Apr 10.
    Safety of Perioperative Immunotherapy Use on Wound Healing After Surgery for Spinal Metastases.
    Yuanxuan Xia, Xinlan Yang, Taha Khalilullah, Abdul Karim Ghaith, Pritika Papali, Anthony Davidson, Joseph M Dardick, Jawad M Khalifeh, Tej D Azad, Landon J Hansen, Nicholas Theodore, Sang H Lee, Timothy F Witham, Ali Bydon, Daniel Lubelski.
       BACKGROUND AND OBJECTIVES: Immunotherapy has become a mainstream part of cancer care, but the immune system is also critical for wound healing. Dysregulating immunity to treat cancer raises concerns about potential iatrogenic effects on postoperative recovery. Despite its growing use, immunotherapy's impact on surgical wound healing remains poorly characterized. In this study, we investigate the relationship between immunotherapy and wound healing in patients after surgery for spinal metastases.
    METHODS: Patients 18 years and older who underwent surgery for spinal metastases from 2012 to 2024 at a comprehensive cancer center were retrospectively evaluated. Demographics, comorbidities, tumor histology, and therapy regimens were catalogued. Instances of "perioperative" (within 12 months before or 3 months after surgery) immunotherapy, radiotherapy, targeted therapy, and chemotherapy were noted. The primary outcome was wound complications, stratified by level of management: antibiotics with routine local care, nonroutine local care, or revisions surgery.
    RESULTSINALL,: 367 patients were included (mean age 60.5 ± 12.1 years) where the most common primary pathologies were lung (18.0%) and prostate (16.1%). Perioperative immunotherapy was administered to 54/367 (14.7%) patients, predominantly immune checkpoint inhibitors (94.4%). Patients who received immunotherapy had mostly similar complication rates (7.4%) than those who did not (12.8%; P = .262). Furthermore, the time it took until wound issues developed did not differ significantly (immunotherapy 0.8 ± 0.6 vs nonimmunotherapy 1.2 ± 0.7 months; P = .306). On multivariate analysis, patients with sacral location for surgery (odds ratio 5.84, 95% CI 1.35-25.30, P = .018) had increased odds of wound complications. Perioperative immunotherapy use did not elevate the odds of wound complications (odds ratio 0.40, 95% CI 0.09-1.69, P = .211). Perioperative radiation, chemotherapy, and targeted therapy were not associated with an elevated risk of complications.
    CONCLUSION: Perioperative immunotherapy use for spinal metastases seems clinically safe without major wound healing implications. These findings suggest immunotherapy can be safely administered to patients during surgical planning for spinal metastases.
    Keywords:  Immunotherapy; Spinal metastases; Wound healing
    DOI:  https://doi.org/10.1227/neu.0000000000004045
  5. Int J Gen Med. 2026 ;19 592374
    Using the Systemic Inflammatory Response Index and the Prognostic Nutritional Index in Predicting Subsequent Bone Metastases in Patients with Non-Small Cell Lung Cancer.
    Peng Wang, Xiaojing Yan, Guangxuan Yan, Dan Li, Li Ma.
       Objective: This study aimed to identify the risk factors for Bone Metastases (BM) in patients with non-small cell lung cancer (NSCLC) and develop a scoring system combining the systemic inflammatory response index (SIRI) and prognostic nutritional index (PNI) to predict subsequent bone metastases in patients with NSCLC.
    Methods: A retrospective analysis of patients with NSCLC treated at our hospital between February 2019 and January 2025 was conducted. Based on the occurrence of BM during follow-up, patients were stratified into the BM or the non-BM group. After their preoperative SIRI and PNI values were calculated, receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values for SIRI and PNI, which were used to establish the SIRI-PNI scoring system. The SIRI-PNI scores were compared between the groups, and univariate and multivariate logistic regression analyses were performed to identify factors influencing BM development.
    Results: Among the 418 patients included with a mean follow-up of 11.91 ± 0.88 months (range: 9-14 months), 142 were diagnosed with BM (33.97%). ROC analysis determined an optimal threshold of 539.0 for the SIRI (area under the curve [AUC] = 0.877; 95% confidence interval [CI]: 0.807-0.947) and 44.8 for the PNI (AUC = 0.801; 95% CI: 0.689-0.912). An SIRI-PNI scoring system was established, with scores ranging from 0 to 2. Clinical stage, lymph node metastasis, and SIRI-PNI score significantly differed between the BM and non-BM groups (P < 0.05). Multivariate analysis identified clinical stage IV (odds ratio = 11.91, P < 0.0001) and a SIRI-PNI score of 2 (P < 0.0001) as independent risk factors for BM.
    Conclusion: Advanced clinical stage (IV) and a high SIRI-PNI score (2 points) are significant prognostic indicators for BM development in patients with NSCLC. The preoperative SIRI-PNI scoring system may facilitate early identification of high-risk patients.
    Keywords:  bone metastases; non-small cell lung cancer; prediction; prognostic nutritional index; systemic inflammatory response index
    DOI:  https://doi.org/10.2147/IJGM.S592374
  6. Insights Imaging. 2026 Apr 07. pii: 89. [Epub ahead of print]17(1):
    Chinese expert consensus on magnetic resonance-guided focused ultrasound surgery for painful bone metastases.
    Xuhui Fan, Na Tang, Jianjun Gu, Xiaorui Yin, Depeng Liu, Jiakang Shen, Junhai Zhang, Shengping Wang, Han Wang.
      Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is an emerging noninvasive treatment for painful bone metastases. The therapeutic mechanism involves precise thermal ablation of periosteal nerve endings combined with controlled necrosis of tumor-involved soft tissue, achieving both immediate pain relief and local disease control. Compared to conventional treatments such as opioid therapy, radiation, or chemotherapy, MRgFUS offers distinct advantages, including non-addictiveness, rapid pain relief, minimal systemic side effects, and excellent patient tolerance. To standardize and optimize MRgFUS clinical practice, the Radiology Department Association of Hospitals of Shanghai and the Micro/Non-invasive Treatment Committee of the Chinese Research Hospital Association have jointly developed this expert consensus document through a structured face-to-face consensus meeting involving 29 experts, combined with anonymous voting. This consensus comprehensively outlines the clinical application of MRgFUS, detailing indications and contraindications, while establishing standardized protocols for preoperative multidisciplinary evaluation, intraoperative workflow (encompassing team responsibilities, technical specifications, treatment planning, and real-time thermal monitoring), postoperative care, adverse event management, and long-term follow-up to assess treatment efficacy and safety outcomes. This consensus further proposes future development strategies for MRgFUS, emphasizing the establishment of global case data registries for collaborative research and the application of AI technologies to identify optimal candidates, thereby standardizing and optimizing procedural efficiency to advance MRgFUS applications in painful bone metastases. CRITICAL RELEVANCE STATEMENT: This expert consensus provides a detailed analysis of the advantages and target populations of MRgFUS, along with comprehensive technical considerations for the procedure. KEY POINTS: Magnetic resonance-guided focused ultrasound surgery (MRgFUS) requires expert consensus to standardize clinical application. MRgFUS is an effective alternative therapy‌, and this consensus detailed MRgFUS operational standards for painful bone metastases. This consensus enhances operator understanding of MRgFUS and facilitates its clinical adoption for painful bone metastases.
    Keywords:  Expert consensus; Magnetic resonance-guided focused ultrasound; ‌Metastatic bone pain
    DOI:  https://doi.org/10.1186/s13244-026-02268-7
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