bims-rebome 2026-04-19 papers

bims-rebome

Biomed News

on Management of bone metastases

Issue of 2026–04–19
eight papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata

Clinical diagnosis of spinal metastases: a narrative review.
Systemic management of spinal metastases: current strategies and future directions.
Prognostic Accuracy of Eight Scoring Systems in Untreated Patients with Spinal Metastases: A Comparative Study.
A Retrospective Cohort Analysis Evaluating the Utility of the Spinal Instability Neoplastic Score (SINS) in Screening for Spinal Instability and Vertebral Compression Fracture Risk in Plasma Cell Neoplasm and Lymphoma Lesions.
Deep Learning Magnetic Resonance Imaging Algorithm for Differentiating Metastatic Vertebral Fractures.
Analysis of Skeletal-Related Events in a Liaison Treatment for Metastatic Spinal Tumors: A 10-Year Retrospective Study.
Is strict use of denosumab or zoledronate Beneficial to patients with bone metastatic Disease?
Challenges in the management of bone metastases: focus on differentiated thyroid cancer and neuroendocrine tumors.

Neurochirurgie. 2026 Apr 09. pii: S0028-3770(26)00044-5. [Epub ahead of print] 101810

Clinical diagnosis of spinal metastases: a narrative review.

Christophe Joubert, Rayan Fawaz, Philemon Robert, Mathilde Fouet, François-Léopold Maison, Bogdan Ene, Jean-Marc Delmas.

  Spinal metastases are a frequent and disabling manifestation of systemic cancer. Pain, neurological compromise, and functional decline dominate the clinical picture, yet diagnostic delays remain common despite widespread MRI availability. To synthesize contemporary evidence on the clinical diagnosis of spinal metastases, emphasizing context‑dependent reasoning, characteristic clinical patterns, key differential diagnosis, and the central role of structured clinical examination. The review integrates recent epidemiological data, highlighting the influence of tumor histology, frailty, and treatment‑related toxicities on presentation. Pain phenotypes, radicular and myelopathic signs, and systemic symptoms are detailed, along with common mimickers such as osteoporotic fractures, spondylodiscitis, spinal hematoma, and chemotherapy‑induced peripheral neuropathy. The manuscript underscores the diagnostic and prognostic value of standardized neurological assessment (Frankel,ASIA), mechanical evaluation (SINS), and global patient appraisal through performance status and frailty measures. Historical prognostic scores (Tokuhashi, Tomita, Bauer, OSRI) and contemporary frameworks such as NOMS are discussed as structured extensions of clinical examination. Strengthening clinical examination skills and integrating neurological, mechanical, oncologic, and systemic dimensions are essential to reduce diagnostic delays and guide personalized, multidisciplinary management of spinal metastases.

Keywords:  clinical diagnosis; differential diagnosis; metastatic epidural spinal cord compression; neurological assessment; spinal metastases

DOI:  https://doi.org/10.1016/j.neuchi.2026.101810
Neurochirurgie. 2026 Apr 09. pii: S0028-3770(26)00043-3. [Epub ahead of print]72(3): 101809

Systemic management of spinal metastases: current strategies and future directions.

H Collin, S Muller, M Ferreira, M Cancel.

  Bones are a common dissemination site in prostate, breast, lung, and renal cancers. Bone metastases are associated with significant morbidity and reduced overall survival. The spine is the most frequently involved site, where metastases can lead to skeletal-related events (SREs) such as pain, pathological fractures, and spinal cord compression. Management of spinal metastases (SM) relies on a multidisciplinary approach combining local treatments (surgery, radiotherapy, interventional procedures) and systemic therapies. Bone-targeting agents, including bisphosphonates and denosumab, have demonstrated efficacy in reducing SRE incidence, although their use remains suboptimal in clinical practice. Conventional systemic therapies such as chemotherapy and endocrine therapy may negatively impact bone health and show limited efficacy in controlling SM. Immune checkpoint inhibitors have transformed the treatment landscape of several metastatic cancers, yet their activity in bone metastases appears reduced, likely due to the specific bone microenvironment. Targeted therapies represent the most promising systemic approach, with variable but sometimes significant activity in SM depending on tumor type and molecular profile. Optimal management of SM requires individualized, multidisciplinary strategies to optimize systemic disease control, local tumor management, and prevention of SREs.

Keywords:  Bone-modifying agents; Chemotherapy; Immunotherapy; Multidisciplinary tumor board; Spinal metastases; Systemic therapy; Targeted therapy

DOI:  https://doi.org/10.1016/j.neuchi.2026.101809
Spine Surg Relat Res. 2026 Mar 27. 10(2): 195-203

Prognostic Accuracy of Eight Scoring Systems in Untreated Patients with Spinal Metastases: A Comparative Study.

Shuhei Ohyama, Yasuhiro Shiga, Yuki Shiratani, Noriyasu Toshi, Yuki Nagashima, Kosuke Takeda, Soichiro Tokeshi, Kohei Okuyama, Noritaka Suzuki, Masahiro Inoue, Kazuhide Inage, Sumihisa Orita, Seiji Ohtori, Takeo Furuya.

   Introduction: To compare the prognostic accuracy of eight widely used scoring systems and their Primary Tumor-Independent (PTI) versions in untreated patients with spinal metastases (SPM).
Methods: Data from 108 untreated patients with SPM diagnosed between 2017 and 2023 were retrospectively analyzed. Prognostic accuracy was assessed for eight scoring systems: Skeletal Oncology Research Group (SORG) Nomogram, New Katagiri score, Revised Tokuhashi Score, Tomita Score, New England Metastatic Spinal Score, Modified Bauer Score, Oswestry Spinal Risk Index, and van der Linden Score. PTI versions were also evaluated by excluding primary tumor information. Predictive accuracy was assessed using receiver operating characteristic analysis at 90 days, 180 days, and 1 year.
Results: At 90 days, the New Katagiri score demonstrated the highest predictive accuracy (area under the curve [AUC]=0.788). The SORG Nomogram exhibited the highest accuracy at 180 days (AUC=0.759) and 1 year (AUC=0.749). In PTI analysis, the SORG Nomogram-PTI retained the highest accuracy at 90 days (AUC=0.728) and 180 days (AUC=0.719).
Conclusions: The New Katagiri score and the SORG Nomogram demonstrated high prognostic accuracy for untreated SPM patients, with the SORG Nomogram-PTI maintaining strong predictive performance even without primary tumor information. These scoring systems are valuable tools for survival estimation and clinical decision-making in this challenging patient population.

Keywords:  primary tumor; scoring system; spinal metastases; survival

DOI:  https://doi.org/10.22603/ssrr.2025-0252
Spine J. 2026 Apr 13. pii: S1529-9430(26)00112-9. [Epub ahead of print]

A Retrospective Cohort Analysis Evaluating the Utility of the Spinal Instability Neoplastic Score (SINS) in Screening for Spinal Instability and Vertebral Compression Fracture Risk in Plasma Cell Neoplasm and Lymphoma Lesions.

Joshua L Golubovsky, George A Crabill, Akshath Rajan, Ian Messing, Elie Massaad, Bonnie Y Hu, Claudia Hejazi-Garcia, Connor A Wathen, Michael Shost, Ali K Ozturk, John H Shin, Cara A Cipriano, Kristy L Weber, Gabrielle W Peters, Anish A Butala, Neil R Malhotra, James M Schuster.

   BACKGROUND CONTEXT: Spinal column tumors with Spinal Instability Neoplastic Scores (SINS) suggesting instability often trigger referrals to spine surgeons. Plasma cell lesions and lymphoma are highly radiosensitive histologies, and may re-ossify after radiation therapy. The SINS score, designed to assess the need for surgical stabilization for spinal neoplasms, may therefore overestimate instability in patients with these radiosensitive histologies.
PURPOSE: Herein we seek to determine if the SINS score is significantly correlated with lesion instability and vertebral compression fracture progression in patients with plasma cell neoplasms or lymphoma of the spine.
STUDY DESIGN: This was a retrospective single-institution cohort analysis.
PATIENT SAMPLE: Patients with spinal plasma cell or lymphoma lesions with identifiable primary lesions were found by querying our institutional electronic medical record from 2010-2024. All patients were at least 18 years of age.
OUTCOME MEASURES: Demographics, comorbidities, symptoms, radiation data, surgical data, and imaging data were collected. Outcomes included development of spinal instability, new or progressive vertebral compression fracture, and follow-up neurological status.
METHODS: Multivariable logistic regressions were used to evaluate categorical outcomes, while Kaplan-Meier analysis was utilized to assess time to mortality.
RESULTS: 240 patients were identified with a mean SINS of 9.79. 23 patients had lesions classified as stable (SINS 0-6, 9.8%), 183 had lesions classified as possibly unstable (SINS 7-12, 76.3%), and 34 had lesions classified as unstable (SINS 13-18, 14.2%). 27 patients underwent surgical management (2 SINS stable, 20 possibly unstable, and 5 unstable), with a 90-day reoperation rate of 11.1% and a 90-day readmission rate of 29.6%. At 3-month follow-up, factors associated with development of instability were higher total SINS score (odds ratio (OR) 1.38, p < 0.001), SINS unstable lesions compared with possibly unstable lesions (OR 2.69, p = 0.028), younger age (OR 0.98 per year, p < 0.001), and higher radiation biologically effective dose (OR 1.03, p < 0.001). Meanwhile, factors associated with new or progressive vertebral compression fracture were higher total SINS score (OR 1.45, p < 0.001), SINS unstable lesions compared with possibly unstable (OR 3.59, p = 0.002), possibly unstable lesions compared with stable (OR Stable 0.22, p = 0.029), and increased age (OR 1.01 per year, p < 0.001), while larger baseline VB height (OR 0.91, p < 0.001) and bisphosphonate or RANK-ligand inhibitor use (OR 0.61, p = 0.009) were protective. SINS was not significantly associated with follow-up neurological status.
CONCLUSIONS: SINS is a useful prognostic factor for the development of instability and new or progressive vertebral compression fracture in patients with plasma cell or lymphoma spinal lesions. However, current thresholds used to define the possibly unstable category may not reliably reflect true instability in these radiosensitive lesions. Surgical decision-making paradigms must be carefully assessed in these patients, given the significant rates of morbidity associated with surgical management of these lesions.

Keywords:  Lymphoma; Multiple Myeloma; Plasma Cell Neoplasm; Spinal Instability Neoplastic Score

DOI:  https://doi.org/10.1016/j.spinee.2026.04.018
Spine J. 2026 Apr 12. pii: S1529-9430(26)00099-9. [Epub ahead of print]

Deep Learning Magnetic Resonance Imaging Algorithm for Differentiating Metastatic Vertebral Fractures.

Joonghyun Ahn, Young-Hoon Kim, Sang-Il Kim, Jun-Seok Lee, Hyung-Youl Park, Ji-Hyun Ryu, Chungwon Bang, Kee-Won Rhyu, Jae-Hyuk Shin, Youjin Shin, June Lee, Seung Jae Moon, Jae Chul Lee.

   BACKGROUND CONTEXT: Distinguishing malignant metastatic lesions from benign osteoporotic vertebral compression fractures (VCFs) is a major diagnostic challenge in spine practice; delays or errors can lead to inappropriate management and missed opportunities for timely oncologic intervention.
PURPOSE: To develop and validate a deep learning-based object detection algorithm using routine MRI sequences to differentiate malignant metastatic lesions from benign VCFs.
STUDY DESIGN/SETTING: Retrospective multicenter study conducted across six tertiary hospitals.
PATIENT SAMPLE: A total of 2,165 patients with either VCFs or spinal metastases were included, encompassing 27,543 vertebral levels. Sagittal T1- and T2-weighted MRI series were available for all participants and were annotated by spine specialists.
OUTCOME MEASURES: Primary outcome: vertebral-level detection/classification performance measured by mean Average Precision across intersection over union thresholds (mAP50-95).
SECONDARY OUTCOMES: Precision, Recall, and F1-score; qualitative error analysis METHODS: : Four object detection models (YOLOv5, YOLOv8, YOLOv11, DETR) were trained and validated on annotated sagittal T1- and T2-weighted images. The dataset was split into training, validation, and test images. Model performance was evaluated using mAP50-95, Precision, Recall, and F1-score on the test set, with qualitative review of misclassifications. Ground-truth was defined by finalized radiology reports and clinical diagnoses; annotators were blinded to model outputs.
RESULTS: YOLOv11 with a ResNet-101 backbone achieved the best overall performance (Precision 91.2%, Recall 92.5%, F1-score 91.9%, mAP50-95 80.2%). YOLOv8 showed the highest Recall (93.3%), supporting potential use for screening, whereas YOLOv11 balanced Precision and Recall, minimizing false negatives. Qualitative analysis demonstrated robust detection in difficult scenarios, including multiple concurrent lesions and coexisting benign and malignant fractures. Misclassifications were uncommon and predominantly involved intravertebral vacuum cleft signs that were not explicitly modeled as a class.
CONCLUSIONS: A deep learning-based object detection approach can accurately distinguish malignant metastatic lesions from benign VCFs on routine MRI. In this large multicenter study, YOLOv11 showed the most balanced performance and may serve as a practical decision-support tool to expedite oncologic referral, improve diagnostic accuracy, and optimize treatment strategies.

Keywords:  Bone metastasis; Deep learning; Object detection; Vertebral compression fracture

DOI:  https://doi.org/10.1016/j.spinee.2026.04.010
Spine Surg Relat Res. 2026 Mar 27. 10(2): 290-295

Analysis of Skeletal-Related Events in a Liaison Treatment for Metastatic Spinal Tumors: A 10-Year Retrospective Study.

Seiya Watanabe, Kazuo Nakanishi, Kazuya Uchino, Hideaki Iba, Yoshihisa Sugimoto, Shigeru Mitani.

   Introduction: Skeletal-related events (SREs), including pathological fractures and spinal cord compression, significantly reduce the quality of life and survival in patients with metastatic spinal tumors. Although multidisciplinary "liaison treatment" has been implemented at our institution to detect and manage all metastatic spinal lesions, some patients still develop SREs. This study aims to analyze the characteristics and circumstances of patients who experienced SREs despite this system, with particular focus on referrals from other hospitals.
Methods: We reviewed patients who developed SREs between December 2013 and December 2023 at our institution. Clinical data including age, sex, performance status (PS), spinal instability neoplastic score (SINS), primary tumor type, spinal lesion level, histologic subtype, epidural spinal cord compression (ESCC) grade, and timing of spine intervention were analyzed. PS at initial and final visits was compared using the Wilcoxon signed-rank test.
Results: Among 1,479 patients with metastatic spinal tumors, 72 (4.8%) developed SREs. Median age was 71 years; 69% were male. PS significantly improved from 3.1 to 2.4 (p=0.0002). SINS averaged 8.9, with 72.4% of cases showing intermediate instability. Thoracic spine involvement was most frequent (59.7%). Prostate, lung, and breast cancers accounted for over 50% of cases. ESCC grade ≥II was present in 62.5%. Notably, 54.2% (39/72) were referred after the onset of an SRE; 77% of these occurred at other hospitals. Furthermore, 69.5% had no prior cancer diagnosis before the SRE.
Conclusions: Despite an in-house liaison system, SREs frequently occurred in patients referred from external institutions. Early recognition of red-flag symptoms, such as back pain in cancer patients and timely referral for imaging and specialist evaluation are essential. Regional collaboration and education are crucial to prevent avoidable SREs.

Keywords:  liaison treatment; metastatic spinal tumor; skeletal-related event

DOI:  https://doi.org/10.22603/ssrr.2025-0181
J Bone Oncol. 2026 Jun;58 100756

Is strict use of denosumab or zoledronate Beneficial to patients with bone metastatic Disease?

Ching-Wei Lin, Han-Ying Wang, Cheng-En Yu, Hung-Kuan Yen, Wei-Hsin Lin, Shau-Huai Fu, Jen-Chang Ko, Chih-Wei Chen.

   Background: Metastatic bone disease presents significant global challenges, necessitating effective strategy to prevent skeletal-related events (SREs) such as fractures and spinal cord compression. Denosumab and zoledronic acid have emerged as promising therapeutic options. However, the optimal dosing intervals remain to be defined.
Methods: This retrospective study, utilizing the institutional integrative medical database from single medical center, involving 1,045 adults with metastatic bone disease who had underwent surgery or radiotherapy for SREs. The study aimed to investigate whether extended dosing intervals for denosumab or zoledronate are associated with increased need for subsequent local treatment for subsequent SREs and a decreased risk of osteonecrosis of the jaw (ONJ). Patients receiving less than two doses within the initial six months after local treatment for bone metastasis were defined as the rarely-used group. The patients having 2-4 doses were in the occasionally-used group and those with more doses were in the strictly-used group.
Results: The subsequent SRE incidences were 27%, 16%, and 18% for the rarely-used, occasionally-used, and strictly-used groups, respectively. The occasionally-used group demonstrated comparable risks of SREs to the strictly-used group, while the rarely-used group showed increased risks. The ONJ incidence was significantly higher in the strictly-used patients (12%) versus the occasionally-used (3%).
Conclusion: A less frequent dosing schedule (2-4 injections in the first six months) for denosumab or zoledronic acid was associated with a lower ONJ risk without a significant increase in subsequent SRE risk after local treatment for bone metastasis in our study. Strict monthly dosing was associated with a higher ONJ risk in our series. These outcomes should be interpreted cautiously due to the retrospective design and heterogeneity of the primary tumors.

Keywords:  Bone metastasis; Denosumab; Osteonecrosis of the Jaw; Skeletal-related event; Zoledronic acid

DOI:  https://doi.org/10.1016/j.jbo.2026.100756
J Endocr Soc. 2026 May;10(5): bvag065

Challenges in the management of bone metastases: focus on differentiated thyroid cancer and neuroendocrine tumors.

Julie Chen, Joy Y Wu.

  Bone metastases represent an uncommon but clinically significant complication in endocrine malignancies including differentiated thyroid cancer and neuroendocrine tumors. Although these malignancies typically follow an indolent course, the development of bone metastases is associated with a worse prognosis and increased risk of skeletal-related events. The optimal strategies for the prevention and management of bone metastases in these patients remain unclear and are largely extrapolated from studies in other solid tumors. This presents a unique clinical challenge as treatment decisions need to balance the prevention of skeletal-related events against the potential risks of prolonged antiresorptive therapy in patients expected to have a long survival time. This article reviews the clinical complexities involved in managing bone metastases in differentiated thyroid cancer and neuroendocrine tumors. The clinical cases presented highlight key considerations to guide clinical decision-making when treating these specific patient populations.

Keywords:  antiresorptive; bisphosphonate; bone metastases; neuroendocrine tumors; skeletal-related events; thyroid cancer

DOI:  https://doi.org/10.1210/jendso/bvag065