bims-rebome 2026-06-07 papers

bims-rebome

Biomed News

on Management of bone metastases

Issue of 2026–06–07
nine papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata

Evidence-based management of metastatic spinal cord compression (MSCC): expert recommendations for standardizing care in Spain.
Prognostic parameters for local control and survival after radiotherapy of stabilized bone metastases.
Cement augmentation of pedicle screw constructs as a modifier of hardware failure risk in instrumented metastatic spine surgery: a systematic review and meta-analysis.
Clinical and geriatric factors associated with fracture risk in older adults with bone metastases: A prospective observational study.
Vertebral metastatic disease: A paradigm shift.
Denosumab versus bisphosphonates for the management of bone metastases originating from breast cancer: a systematic review and meta-analysis.
Impact of complications on survival after surgery for metastatic spinal cord compression.
Is preoperative body mass index associated with 30-day mortality after oncologic surgery for spinal metastases? An ACS-NSQIP analysis.
CORR Insights®: External Evaluation Reveals Reduced Performance of the PathFX Survival Model in 1018 Patients With Extremity Metastases.

Clin Transl Oncol. 2026 Jun 02.

Evidence-based management of metastatic spinal cord compression (MSCC): expert recommendations for standardizing care in Spain.

Antonio José Conde-Moreno, Almudena Pérez-Lara, Carlos Ferrer-Abiach, Teresa Bas, Silvia Ceruelo-Abajo, María Victoria Lorenzo Suberviola, Rosa María Rodríguez-Alonso, Alfonso Vázquez, Héctor Roldán, Jon Cacicedo.

  Metastatic spinal cord compression (MSCC) is a severe oncological emergency that may cause irreversible neurological damage if not recognized and treated promptly. In patients with known or suspected malignancy, spinal pain, particularly if progressive, or new motor, sensory, or sphincter symptoms should raise immediate suspicion of MSCC. MRI should be performed within 24 h of clinical suspicion. In patients with neurological signs or symptoms, initial emergency management should include immediate corticosteroid administration, urgent multidisciplinary assessment, and rapid initiation of definitive treatment. Surgery, when indicated, should be performed as early as feasible (ideally within 8-24 h when indicated); when surgery is not planned or not indicated, radiotherapy should be started promptly. This multidisciplinary expert opinion document provides practical recommendations to support standardized urgent pathways and coordinated multidisciplinary management of MSCC.

Keywords:  Magnetic resonance imaging; Metastatic spinal cord compression; Multidisciplinary management; Oncological emergency; Spinal metastases

DOI:  https://doi.org/10.1007/s12094-026-04345-1
Strahlenther Onkol. 2026 Jun 01.

Prognostic parameters for local control and survival after radiotherapy of stabilized bone metastases.

Vlatko Potkrajcic, Dominik Wahl, Sandra Frantz, Elgin Hoffmann, David Baumann, Kerstin Clasen, Verena Gassenmaier, Tatevik Mrva-Ghukasyan, Maximilian Niyazi, Frank Paulsen, Frank Traub, Franziska Eckert.

   BACKGROUND: Postoperative radiotherapy following surgical stabilization in patients with bone metastases is commonly recommended. The aim of the study was to validate existing prognostic scores and parameters for local control and survival in patients with bone metastases treated with surgical resection with or without radiotherapy.
METHODS: This retrospective single-institution study analyzed consecutive patients with bone metastases undergoing resection and/or stabilization mostly due to pathologic or impending fractures (with or without spinal compression). Additive radiotherapy was considered the standard of care. Various fractionated radiotherapy regimens have been applied; equivalent dose in 2 Gy fractions (EQD2) has been calculated to enable comparison between fractionations. Prognostic factors influencing local progression-free survival (LPFS) and overall survival (OS) were evaluated.
RESULTS: The median follow-up was 9 months (range 1-121 months). A total of 142 patients were included. Most patients underwent surgery due to pathologic (n = 86, 60.6%) or impending fracture (n = 54, 38.0%), with or without spinal compression. Most common histologies were breast (n = 30, 21.1%) and lung cancer (n = 30, 21.1%); most common metastasis locations were spine (n = 58, 40.8%), lower (n = 56, 39.4%) and upper extremities (n = 23, 16.2%). Postoperative radiotherapy was performed in 89 patients (62.7%). Location in the spine and prior irradiation were identified as poor prognostic factors for LPFS. In patients with spine metastases, improved LPFS was demonstrated in those treated with postoperative radiotherapy (2 years LPFS 96.7% ± 3.3% vs. 23.4 ± 19.0%; p = 0.003). Postoperative radiotherapy did not improve LPFS in patients with bone metastases outside the spine (p = 0.960). Better OS rates were demonstrated in patients with good performance status (ECOG) and with moderate and good prognosis according to the Tokuhashi score.
CONCLUSION: Our real-life data revealed that a significant number of patients did not receive postoperative radiotherapy for various reasons. Established prognostic scores (Tokuhashi and ECOG score) correlate with patient survival, and their use should be encouraged to determine optimal patient treatment and to identify patients who may benefit from postoperative radiotherapy, due to their longer life expectancy. LPFS improved with postoperative radiotherapy in spinal bone metastases, but not in nonspinal metastases.

Keywords:  Bone metastases; Pathologic fracture; Postoperative radiotherapy; Spine metastases; Surgery

DOI:  https://doi.org/10.1007/s00066-026-02539-8
Eur Spine J. 2026 Jun 03.

Cement augmentation of pedicle screw constructs as a modifier of hardware failure risk in instrumented metastatic spine surgery: a systematic review and meta-analysis.

Ying-Ching Li, Cheng-Yu Li, Sheng-Han Huang, Hong-Kai Wang, Kuan-Hung Chen, Yan-Po Kang, Peng-Wei Hsu, Yu-Jen Lu.

   PURPOSE: Hardware failure (HF) after instrumented fixation for spinal metastases affects 2-22% of patients. Despite growing adoption of cement-augmented pedicle screw fixation (CAPS), no meta-analysis has quantified its effect on HF rates. We aimed to provide pooled HF estimates for CAPS versus conventional fixation and explore the Spinal Instability Neoplastic Score (SINS) as a potential effect modifier.
METHODS: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines, searching five databases through April 2026. Pooled HF rates were computed using Freeman-Tukey double arcsine transformation with DerSimonian-Laird random-effects models. Sensitivity analysis was performed restricting to SINS-reporting studies. Certainty of evidence was assessed using GRADE.
RESULTS: Thirteen studies (n = 886) met eligibility criteria. The pooled HF rate was 4.3% (95% CI 1.8-7.9%; I² = 46.8%) in CAPS arms (k = 10, n = 349) versus 12.5% (95% CI 2.9-27.5%; I² = 93.3%) in non-augmented controls (k = 5, n = 537). The sole comparative study demonstrated OR 0.13 (95% CI 0.02-0.81; p = 0.029). Sensitivity analysis restricted to SINS-reporting studies confirmed stability (4.5%, I² = 23.4%). All outcomes were rated low to very low certainty.
CONCLUSION: CAPS was associated with a numerically lower pooled HF rate compared to conventional fixation in metastatic spine surgery (4.3% vs. 12.5%; indirect comparison). While certainty of evidence was low to very low, these findings may inform implant strategy decisions and highlight the need for standardised HF definitions. INPLASY registration: INPLASY202640045.

Keywords:  Cement augmentation; Hardware failure; Meta-analysis; Pedicle screw; Spinal metastases; Systematic review

DOI:  https://doi.org/10.1007/s00586-026-10060-w
Support Care Cancer. 2026 Jun 04. pii: 611. [Epub ahead of print]34(6):

Clinical and geriatric factors associated with fracture risk in older adults with bone metastases: A prospective observational study.

İnci Güner, Serkan Akın, Nadir Yalçın.

   PURPOSE: Bone metastases frequently lead to fractures, causing substantial morbidity, impaired quality of life, and poor prognosis in older adults with cancer. This study aimed to evaluate fracture risk by integrating geriatric parameters with clinical and oncological factors in older patients with bone metastases.
METHODS: This prospective observational study included 55 patients aged ≥ 65 years with newly diagnosed bone metastases who initiated monthly parenteral antiresorptive therapy. Baseline evaluation included standard oncological variables and validated geriatric tools (ADL, MUST, mFI-5, and ACB). Fracture occurrence was monitored over a six-month follow-up period. Univariate Cox regression analyses were performed to identify fracture-associated factors, followed by a theoretically driven multivariable Cox regression model. Correlation analyses were used to assess associations among significant variables.
RESULTS: Fractures occurred in 21 patients (38.2%). Univariate analyses showed that poorer performance status (ECOG ≥ 1; HR = 19.92), moderate functional impairment (ADL 3-5; HR = 8.39), high frailty (mFI-5 ≥ 2; HR = 9.83), osteolytic lesions (HR = 4.87), high anticholinergic burden (ACB ≥ 3; HR = 4.56), malnutrition risk (MUST ≥ 2; HR = 4.30), post-study falls (HR = 4.22), and lung metastases (HR = 2.97) were associated with increased fracture risk. Multivariable analysis identified ECOG score of 1 (aHR = 20.62) and high ACB score (aHR = 5.70) as independent predictors. Reduced functional independence and poorer performance status showed the strongest correlations with fracture occurrence.
CONCLUSION: Fracture risk in older adults with bone metastases is driven predominantly by functional impairment, frailty, and medication-related vulnerability rather than tumor-related factors alone. Integrating geriatric assessment into routine oncology practice may improve fracture risk stratification and supportive care outcomes.

Keywords:  Anticholinergic burden; Bone metastasis; Fractures; Frailty; Functional status; Malnutrition; Older adults

DOI:  https://doi.org/10.1007/s00520-026-10859-9
Neurooncol Adv. 2026 May;8(Suppl 3): iii21-iii36

Vertebral metastatic disease: A paradigm shift.

Annee Nguyen, Trupti Trivedi, Ellen O'Callaghan, Seeley Yoo, Tanner Zachem, Ramzy Ahmed, Rafael De La Garza Ramos, Raphaele Charest-Morin, Mark H Bilsky, Daniel Sciubba, Michelle Clarke, Claudio Tatsui, John H Shin, Ilya Laufer, Ori Barzilai, Ziya L Gokaslan, Arjun Sahgal, Michael Weber, Patricia Leigh Zadnik Sullivan, Nicolas Dea, Áron Lazáry, Trey Mullikin, C Rory Goodwin.

  Vertebral metastatic disease results from many types of cancer and can have a devastating impact on patient mobility, psychological health, quality of life, and ultimately overall patient survival. However, the development of radiotherapy and surgical techniques has rapidly surged in conjunction with ongoing advances in basic science and translational studies. In this review, we discuss the paradigm shift in our understanding of the epidemiology and treatment algorithms for spinal oncology, ranging from preoperative optimization strategies, radiation and surgical techniques, the utilization of molecular markers and targeted therapeutics in medical oncology, and prognostication tools that underscore a new multidisciplinary approach to spinal oncology care.

Keywords:  genomics; radiation oncology; spine metastases; spine oncology; surgery

DOI:  https://doi.org/10.1093/noajnl/vdag011
Future Oncol. 2026 Jun 02. 1-14

Denosumab versus bisphosphonates for the management of bone metastases originating from breast cancer: a systematic review and meta-analysis.

Marc Boutros, Guy Awad, Jean-Pierre Saad, Maria Mitri, Karim Masrouha.

   BACKGROUND: Bone metastases from breast cancer cause skeletal-related events (SREs), including pain, fractures, and the need for radiation or surgery. Denosumab and bisphosphonates (BP) reduce these complications, but their relative efficacy and safety remain unclear.
METHODS: PubMed, Scopus, Cochrane Library, and Google Scholar were searched through October 2025. Five publications (four unique studies: three randomized trials and one retrospective cohort) were included. Sensitivity analyses were limited to randomized trials when feasible. Outcomes included SRE incidence and skeletal endpoints, plus renal, metabolic, hematologic, musculoskeletal, gastrointestinal, infectious adverse events, osteonecrosis of the jaw (ONJ), and serious, grade ≥ 3, and treatment-related events.
RESULTS: Denosumab reduced SREs compared to BP (RR 0.77, p < 0.001). It lowered arthralgia (RR 0.62; p = 0.01), myalgia (RR 0.31; p = 0.005), and bone pain (RR 0.77; p = 0.001), with similar back and extremity pain. Renal adverse events (RR 0.55; p = 0.0002), non-serious events (RR 0.98; p = 0.008), and pyrexia (RR 0.33; p = 0.04) were reduced. Other outcomes, including uNTx, ONJ, serious and grade ≥ 3 events, thrombocytopenia, infectious, gastrointestinal, and respiratory events, were comparable. Results were consistent in randomized-only analyses.
CONCLUSION: In breast cancer patients with bone metastases, denosumab may benefit those at higher risk of renal toxicity or skeletal complications, while treatment decisions should remain individualized.
PROTOCOL REGISTRATION: www.crd.york.ac.uk/PROSPERO identifier is CRD420251231881.

Keywords:  Denosumab; bisphosphonates; bone metastases; breast cancer; osteonecrosis of the jaw; renal toxicity; skeletal-related events; zoledronic acid

DOI:  https://doi.org/10.1080/14796694.2026.2681673
Eur Spine J. 2026 Jun 01.

Impact of complications on survival after surgery for metastatic spinal cord compression.

Martin Isaksson, Nellie Bjerstedt, Grzegorz Pietz, Sead Crnalic, Johan Wänman.

   PURPOSE: Although complications are known to affect mortality in patients with spinal cord compression (MSCC), the impact of specific complication subtypes on survival and their risk factors remain poorly defined. The aim was to identify risk factors for perioperative and postoperative local and systemic complications in patients who underwent surgery for MSCC and to evaluate their association with postoperative survival.
METHODS: We retrospectively analyzed 256 patients who underwent surgical treatment for MSCC between 2003 and 2022. Complications occurring within 30 days postoperatively were classified as perioperative, postoperative local, or postoperative systemic complications. Associations between complications and patient-related variables (age, comorbidities, smoking status, performance status, preoperative ambulatory status, and prior radiotherapy) and surgery-related variables (approach, intraoperative blood loss, and duration of surgery) were examined.
RESULTS: At least one complication occurred in 86 patients (33,6%): 14 perioperative, 39 systemic, and 33 local complications. Postoperative systemic complications (HR 1.8, 95% CI 1.2-2.5; p = 0.003) and lower performance status (HR 1.9, 95% CI 1.4-2.6; p < 0.001), were independently associated with reduced postoperative survival. Impaired preoperative ambulatory function was associated with postoperative complications (HR 2.1, 95% CI 1.0-4.3; p = 0.04).
CONCLUSION: Postoperative systemic complications were associated with reduced survival following surgery for MSCC. Impaired preoperative ambulatory function increases the risk of complications and should be emphasized in preoperative risk assessment and surgical decision-making.

Keywords:  Local complications; Metastatic spinal cord compression (MSCC); Perioperative complications; Spinal surgery; Systemic complications

DOI:  https://doi.org/10.1007/s00586-026-10058-4
J Clin Neurosci. 2026 Jun 03. pii: S0967-5868(26)00271-7. [Epub ahead of print]151 112120

Is preoperative body mass index associated with 30-day mortality after oncologic surgery for spinal metastases? An ACS-NSQIP analysis.

Liza Belman, Ali Haider Bangash, Alexander Alexandrov, Victoria Cao, Esli Najera-Samaniego, Rose Fluss, Sertac Kirnaz, Saikiran G Murthy, Yaroslav Gelfand, Reza Yassari, Rafael De la Garza Ramos.

   STUDY DESIGN: Retrospective cohort study.
OBJECTIVE: To investigate the association between preoperative body mass index (BMI) and 30-day mortality following metastatic spinal tumor surgery (MSTS), with particular emphasis on underweight status as a predictor of early postoperative mortality.
SUMMARY OF BACKGROUND DATA: Surgical intervention for spinal metastases carries substantial perioperative risk. BMI has emerged as a potential prognostic biomarker given its accessibility and relationship to nutritional status and physiological reserve. However, evidence regarding its predictive value remains conflicting. Moreover, the prognostic implications of low BMI are underexplored despite the high prevalence of cancer-related cachexia in this population.
METHODS: Data from the American College of Surgeons National Surgical Quality Improvement Program (2018-2023) were analyzed. Patients with disseminated cancer managed with MSTS were included. Underweight status was defined as BMI < 18.5 kg/m2. The primary endpoint was 30-day all-cause mortality. Univariable and multivariable logistic regression analyses were performed, with covariates selected a priori based on clinical relevance and established predictors of perioperative mortality.
RESULTS: Among 2,098 patients (Mean age: 63 years; 60% male population), mean BMI was 27.3 kg/m2, with 4% (n = 90) patients classified as being underweight. The 30-day mortality rate was 8% (n = 164). On multivariable analysis, preoperative BMI as a continuous variable was independently associated with 30-day mortality (OR 0.96 [95% CI 0.93 to 0.99]; p = 0.016). Underweight status was also independently associated with nearly two-fold increased odds of 30-day mortality (OR 1.95 [95% CI 1.03 to 3.71]; p = 0.04).
CONCLUSION: Lower preoperative BMI is independently associated with increased 30-day mortality following MSTS, with underweight patients facing nearly twice the odds of early postoperative death. Low BMI may serve as a simple, readily available marker of heightened physiologic vulnerability, warranting comprehensive preoperative evaluation of nutritional and functional status in this high-risk population.

Keywords:  BMI; Biomarkers; Frailty; Mortality; Spinal metastases

DOI:  https://doi.org/10.1016/j.jocn.2026.112120
Clin Orthop Relat Res. 2026 Jun 05.

CORR Insights®: External Evaluation Reveals Reduced Performance of the PathFX Survival Model in 1018 Patients With Extremity Metastases.

Duncan C Ramsey.

DOI: https://doi.org/10.1097/CORR.0000000000004022