bims-rebome Biomed News
on Rehabilitation of bone metastases
Issue of 2025–06–15
nine papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata
  1. Electrochemotherapy in the Treatment of Bone Metastases: A Narrative Review.
  2. Exercise interventions in patients with multiple myeloma: a scoping review.
  3. Cancer Pain: Radiotherapy as a Double-Edged Sword.
  4. Oncology Biomarkers, Clinical Characteristics, and Survival Outcomes in Colorectal Cancer Patients with Spinal Metastases Undergoing Spinal Surgery: Insights from a Retrospective Cohort Study.
  5. Evaluation of Adverse Events and the Impact on Health-Related Outcomes in Patients Undergoing Surgery for Metastatic Spine Tumors: Analysis of the Metastatic Tumor Research and Outcomes Network (MTRON) Registry Dataset.
  6. Effects of Remote Web-Based Interventions on the Physiological and Psychological States of Patients With Cancer: Systematic Review With Meta-Analysis.
  7. Short-Segment Fixation with Anterior Support versus Long-Segment Fixation with Separation Surgery for Thoracolumbar Spinal Metastatic Tumors : A Comparative Analysis
  8. Implementation Science as the Secret Sauce for Integrating Exercise Screening and Triage Pathways in Oncology.
  9. Dropping out or Moving on? A Systematic Review With Meta-Aggregation of the Experience of Prehabilitation Among Patients With Cancer.
  1. Cardiovasc Intervent Radiol. 2025 Jun 06.
    Electrochemotherapy in the Treatment of Bone Metastases: A Narrative Review.
    Adlane Feddal, Frédéric Deschamps, Paul Beunon, Thierry De Baère, Lambros Tselikas, Baptiste Bonnet.
      Bone is the third most common site for metastases, frequently leading to skeletal-related events (SREs) such as pain, metastatic epidural spinal cord compression (MESCC), and pathological fractures all of which significantly impact patients' quality of life. In recent years, minimally invasive image-guided therapies have been developed to achieve local tumor control, alleviate pain, and improve functionality, often in conjunction with long-established treatments (chemotherapy, radiation, surgery) and analgesics. Cementoplasty and thermal ablation have demonstrated proven efficacy and safety; however, certain challenging cases remain due to anatomical or tumor-related factors. Innovative techniques such as electrochemotherapy (ECT) are emerging to address these clinical challenges. This review provides an overview of ECT, its role in treatment protocols, and recent data regarding its efficacy in managing bone metastases, with a focus on local control, pain relief, and safety.
    Keywords:  Bone metastases; Electrochemotherapy (ECT); Electroporation; Interventional oncology (IO); Interventional radiology; Metastatic epidural spinal cord compression (MESCC)
    DOI:  https://doi.org/10.1007/s00270-025-04077-9
  2. BMC Sports Sci Med Rehabil. 2025 Jun 09. 17(1): 148
    Exercise interventions in patients with multiple myeloma: a scoping review.
    Jiayao Li, Yi Peng, Di Zhan, Ying Zhang, Shanshan Yu.
       BACKGROUND: Patients with multiple myeloma (MM) frequently experience impaired motor function and reduced quality of life. While exercise interventions play a vital role, no standardized guidelines tailored specifically to MM patients currently exist. This article reviews the scope of exercise interventions for patients with MM and further analyzes the current situation, providing references for early rehabilitation.
    OBJECTIVE: This article aims to systematically analyze the application of exercise interventions in the rehabilitation of patients with MM, clarify the specific content, outcome indicators, and effects of exercise interventions, and provide relevant references for medical staff.
    METHODS: Using a scoping review methodology, we systematically conducted computerized searches across both Chinese (e.g., CNKI, Wanfang, Chinese Biomedical Literature Database) and international databases (e.g., Cochrane Library, PubMed, Embase) in accordance with the PRISMA-ScR checklist. The search timeframe encompassed records from database inception through 1 October 2024. Relevant literature meeting inclusion criteria underwent systematic summarization and critical analysis.
    RESULTS: A total of 17 studies were included, comprising 10 randomized controlled trials (RCTs), 4 single-arm trials, 1 retrospective cohort study, and 2 quasi-experimental studies‌. The types of exercise included aerobic exercise, resistance training, and Nordic walking (with a frequency of 3 to 5 times per week for 30 to 60 min each session).
    CONCLUSION: Although existing studies exhibit inconsistencies in exercise types, parameters, supervision protocols, and limited evidence quality, our scoping review of relevant research findings demonstrates that exercise interventions positively improved fatigue levels, functional capacity, quality of life, and psychological well-being in patients with multiple myeloma (MM). This conclusion holds clinical relevance, as it not only addresses patients' concerns regarding exercise safety but also provides evidence-based guidance for healthcare professionals in developing personalized exercise plans tailored to patients at different treatment stages. Future research should prioritize establishing standardized, individualized exercise protocols based on patient profiles, particularly for those with bone metastases.
    REGISTRATION DETAILS: Open Science Framework ( https://doi.org/10.17605/OSF.IO/UDWM4 ).
    Keywords:  Exercise effect; Exercise interventions; Motion evaluation; Multiple myeloma
    DOI:  https://doi.org/10.1186/s13102-025-01193-4
  3. Int J Mol Sci. 2025 May 29. pii: 5223. [Epub ahead of print]26(11):
    Cancer Pain: Radiotherapy as a Double-Edged Sword.
    Monika Konopka-Filippow, Barbara Politynska, Anna M Wojtukiewicz, Marek Z Wojtukiewicz.
      Cancer pain is a common issue for patients, especially in the advanced stages of cancer, and significantly affects the quality of life (QoL), treatment tolerance, and overall treatment outcomes. Pain may be caused by primary tumors, metastases, or as a consequence of the inflammatory reaction of tissues surrounding the tumor following radiotherapy (RT). Effective pain management is crucial, especially with RT being a key method for alleviating cancer pain, particularly in cases of bone and soft tissue metastases. RT provides relief for 60-80% of patients by reducing tumor size and mitigating associated pain. Radiotherapy itself can also induce pain, especially radiation-induced neuropathic pain, which may require further treatment. Despite these potential side effects, RT remains an essential tool in managing cancer pain, though careful management of its toxicities is necessary to improve patient QoL and survival.
    Keywords:  bone metastases; neuropathic pain; pain; radiotherapy
    DOI:  https://doi.org/10.3390/ijms26115223
  4. Cancers (Basel). 2025 May 22. pii: 1739. [Epub ahead of print]17(11):
    Oncology Biomarkers, Clinical Characteristics, and Survival Outcomes in Colorectal Cancer Patients with Spinal Metastases Undergoing Spinal Surgery: Insights from a Retrospective Cohort Study.
    Abdel-Hameed Al-Mistarehi, Taha Khalilullah, Abdul Karim Ghaith, Mahnoor Shafi, Jawad M Khalifeh, Yuanxuan Xia, Khaled J Zaitoun, Ahmad A Alnasser, Joseph Rajasekaran, Avi N Albert, Siddharth Shah, Nicholas Theodore, Jeffrey Meyer, Kristin J Redmond, Susan L Gearhart, Daniel Lubelski.
      Objectives: This study aims to identify clinical characteristics and biomarkers influencing survival outcomes in colorectal cancer (CRC) patients with spinal metastases. Methods: We conducted a retrospective cohort study involving 27 patients treated for CRC-derived spinal metastases at Johns Hopkins Hospital. Data on demographics, biomarker profiles of the primary colorectal tumor site, surgical outcomes, and survival were collected. Neurological function was assessed pre- and postoperatively using Frankel scores. Survival outcomes included overall survival (OS) and post-metastasis survival. Results: The median age of the patients was 58 years, with 63% being women. The sacral spine was the most frequently involved site (59.3%), followed by the thoracic and lumbar regions. Most patients (89%) already had extraspinal metastases, predominantly in the lungs. Biomarker analysis showed microsatellite stability in 63% of patients and CDX2 (Caudal-type homeobox 2) expression in 37%. Laminectomy was performed in 85% of cases and sacrectomy in 55.6%, leading to postoperative improvements in ambulatory function and neurological status. The main indications included local recurrence of the tumor and neurological deficits attributed to the impinging tumor. The median overall survival was 4.9 years, while the median post-metastasis survival was 3.0 years. Univariable analysis revealed that CK20 expression (p = 0.041) and spinal tumor recurrence (p = 0.045) were significantly associated with shorter post-metastasis survival. Conclusions: This study highlights the prognostic importance of CK20 expression and spinal tumor recurrence in CRC patients diagnosed with spinal metastases. Surgical intervention significantly improved neurological outcomes, enhancing patient quality of life. Further research with larger cohorts is needed to confirm these findings and optimize treatment strategies for this challenging patient population.
    Keywords:  CK20; biomarkers; colorectal cancer; spinal metastases; surgical intervention; survival
    DOI:  https://doi.org/10.3390/cancers17111739
  5. Global Spine J. 2025 Jun 06. 21925682251347247
    Evaluation of Adverse Events and the Impact on Health-Related Outcomes in Patients Undergoing Surgery for Metastatic Spine Tumors: Analysis of the Metastatic Tumor Research and Outcomes Network (MTRON) Registry Dataset.
    AO Spine Knowledge Forum Tumor
      Study DesignThis study is part of the AO Spine Metastatic Tumor Research and Outcomes Network [MTRON], an international multicenter prospective observational registry including patients with spinal metastases.ObjectivesThis study aims to elucidate the incidence of surgical complications, their risk factors and consequent effects on survival outcomes, hospital length of stay, and overall health-related quality of life (HRQOL) parameters in a large cohort of patients affected by spinal metastases who were surgically treated.MethodsAvailable data from February 2017 to July 2023 were analyzed. The primary outcome of this study was the evaluation of the incidence of intraoperative and postoperative adverse events (AEs). The secondary outcomes included the assessment of risk factors for surgery-related AEs and the impact of AEs on survival, length of hospital stay and quality of life.ResultsAmong the 1267 patients analyzed, 6.9% experienced intraoperative AEs and 19.3% experienced at least 1 postoperative AE. Several factors resulted to be associated to the occurrence of postoperative AEs: age, smoking habit, poor Eastern Cooperative Oncology Group (ECOG) Performance status, previous radiation therapy at the index target, duration of surgery, number of instrumented levels, simultaneous anterior and posterior approach, presence of metastases at other sites, multiple spinal metastases. Postoperative AEs were associated with reduced survival rates, increased hospital length of stay and poorer HRQOL outcomes, particularly in domains such as neurological function and mental health. In general, surgery substantially improves HRQOL across multiple domains, with these benefits persisting over time despite the occurrence of AEs. However, patients with preoperative risk factors, including comorbidities, smoking, neurological impairment, and prior radiation therapy, experienced less improvement.ConclusionsThe negative impact of AEs on overall survival and HRQOL could be associated with the presence of some preoperative parameters of frailty that are detected as risk factors for AEs occurrence. This finding emphasizes the need for personalized preoperative assessments and optimized perioperative care strategies.
    Keywords:  adverse events; complications; length of stay; quality of life; spinal metastases; surgical treatment; survival
    DOI:  https://doi.org/10.1177/21925682251347247
  6. JMIR Mhealth Uhealth. 2025 Jun 12. 13 e71196
    Effects of Remote Web-Based Interventions on the Physiological and Psychological States of Patients With Cancer: Systematic Review With Meta-Analysis.
    Lv Tian, Yixuan Wen, Jingmiao Li, Jiexin Guan, Tao Li, Jun Fan.
       BACKGROUND: Patients with cancer may experience physiological and psychological adverse reactions, such as fatigue, pain, anxiety, and depression, which seriously affect their quality of life. Research has shown that remote interventions based on apps or miniprograms may help improve the physiological and mental health of patients with cancer. However, due to the limited number of relevant studies, the impact of web-based interventions in cancer management remains unclear.
    OBJECTIVE: We aimed to determine the efficacy of interventions based on apps, miniprograms, or other web-based tools on the physiological (body pain and fatigue) and psychological (anxiety and depression) states and the quality of life of patients with cancer.
    METHODS: We conducted electronic literature searches in PubMed, Scopus, Web of Science, the Cochrane Library, CINAHL, and EMBASE databases. The search period spanned from the inception of each database to October 15, 2024. Two researchers independently conducted literature retrieval and data extraction. The risk of bias was assessed with the Cochrane risk-of-bias tool, and the quality of evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). All statistical analyses were performed using Review Manager version 5.4.
    RESULTS: A total of 36 randomized controlled trials were included. The remote web-based interventions significantly improved the pain intensity (n=14, 39% studies; standardized mean difference [SMD] -0.39, 95% CI -0.64 to -0.14; I2=82%; GRADE rating=low) and fatigue status (n=11, 31% studies; SMD -0.52, 95% CI -0.95 to -0.09; I2=95%; GRADE rating=low) in patients with cancer. Regarding psychology, the results indicated that the remote web-based interventions significantly improved the anxiety (n=14, 39% studies; SMD -0.60, 95% CI -0.90 to -0.30; I2=91%; GRADE rating=low) and depressive state (n=10, 28% studies; SMD -0.36, 95% CI -0.58 to -0.14; I2=81%; GRADE rating=low) of patients with cancer. For quality of life, the results showed that the remote web-based interventions had a significant positive impact on the quality of life of patients with cancer (n=26, 72% studies; SMD 0.63, 95% CI 0.39-0.87; I2=92%; GRADE rating=low).
    CONCLUSIONS: The remote web-based interventions were effective in reducing the intensity of physiological pain, relieving fatigue, improving depression and anxiety, and improving the quality of life of patients with cancer. However, due to the low certainty of evidence, more rigorous randomized controlled trials are needed to validate these findings further.
    TRIAL REGISTRATION: PROSPERO CRD42024611768; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024611768.
    Keywords:  PRISMA; anxiety; cancer patients; depression; meta-analysis; pain; quality of life; remote web-based intervention
    DOI:  https://doi.org/10.2196/71196
  7. J Korean Neurosurg Soc. 2025 06 09.
    Short-Segment Fixation with Anterior Support versus Long-Segment Fixation with Separation Surgery for Thoracolumbar Spinal Metastatic Tumors : A Comparative Analysis
    Younggyu Oh, Subum Lee, Jinuk Kim, Seo Eun Kim, Cho Jae Hwan, Jin Hoon Park.
       Objective: This study aims to evaluate and compare the clinical and radiographic outcomes of patients with metastatic spinal tumors who underwent either short-segment fixation with anterior support or long-segment fixation with a separation surgery in the thoracic or lumbar spine.
    Methods: We conducted a retrospective analysis of adult patients who were treated surgically for spinal metastases in the thoracic or lumbar spine at a single tertiary referral center between April 2014 and December 2022. Surgical treatments included spinal cord decompression, short-segment fixation with maximal circumferential debulking of the lytic tumor portion and anterior support, or long-segment fixation without anterior support, followed by separation surgery and posterolateral fusion. We compared the two fixation strategies based on patient demographics, preoperative diagnoses, surgical data, neurological assessments, and changes in segmental Cobb angles immediately after surgery, and at the final follow-up.
    Results: A total of 91 patients were included (short-segment = 44, long-segment = 47). No significant differences were observed between the groups regarding age, sex, comorbidities, primary cancer location, postoperative complications, or reoperation rates. Furthermore, no significant differences in the sagittal Cobb angles, including global angle (thoracic kyphosis, lumbar lordosis) and segmental angle were noted from the preop to the final follow-up. Compared to traditional long-segment fixation, short-segment fixation with anterior support significantly improved neurological outcomes in the thoracic region and reduced the length of hospital stay. No significant differences were observed between the two groups regarding complications or other clinical outcomes.
    Conclusion: Short-segment fixation is comparable to long-segment fixation in the management of thoracolumbar metastatic spinal tumors, with no significant differences in radiographic outcomes. However, short-segment fixation provides the added advantages of improved neurological outcomes in the thoracic region and shorter hospital stays.
    Keywords:  Metastatic spinal tumors; Pedicle screw fixation; Separation surgery; Spinal fusion
    DOI:  https://doi.org/10.3340/jkns.2024.0208
  8. Am Soc Clin Oncol Educ Book. 2025 Jun;45(3): e472854
    Implementation Science as the Secret Sauce for Integrating Exercise Screening and Triage Pathways in Oncology.
    Prajakta Adsul, Mackenzi Pergolotti, Kathryn H Schmitz.
      Oncology rehabilitation and exercise (ORE) exist along a continuum of care, providing essential services for patients with cancer to improve health outcomes. Although oncology rehabilitation, typically delivered by licensed medical professionals, is often covered by third-party payers, exercise oncology remains largely unfunded despite its strong evidence base. Research indicates that exercise interventions improve cancer-related fatigue, physical function, mental health, and quality of life, yet referral and implementation remain limited. A geospatial analysis highlights disparity in program availability, particularly in rural and underserved areas. Effective ORE programs require systematic planning, institutional support, clinical workflow integration, and sustainable funding. Case analyses suggest that program adoption depends on leadership buy-in, organizational readiness, and structured referral pathways. Implementation science (IS) provides a framework to address real-world barriers, ensuring efficient integration of exercise services into oncology care. Screening and triage models can aid in patient assessment, streamlining referrals to appropriate levels of exercise intervention. Despite growing policy efforts, widespread third-party reimbursement remains elusive. Leveraging IS strategies can facilitate the adoption and sustainability of ORE programs, bridging the gap between research and practice. Future directions should focus on improving clinician education, expanding access through policy initiatives, and integrating exercise interventions into standard oncology care to optimize patient outcomes.
    DOI:  https://doi.org/10.1200/EDBK-25-472854
  9. J Clin Nurs. 2025 Jun 12.
    Dropping out or Moving on? A Systematic Review With Meta-Aggregation of the Experience of Prehabilitation Among Patients With Cancer.
    Ting Zhang, Dan Su, Shuwen Li, Yajuan Yang.
       BACKGROUND: The effect of prehabilitation on reducing the level of postoperative stress and facilitating recovery has been proven to be controversial in previous studies involving patients with cancer. This review contributes to the improvement of an intervention programme by qualitatively integrating the prehabilitation experiences of patients with cancer.
    OBJECTIVE: This review aimed to integrate the individual experiences of patients with cancer who had received prehabilitation interventions to identify the barriers and facilitators to implementation, which can be used to understand patients' adherence behaviours.
    DESIGN: This was a qualitative evidence synthesis review.
    METHODS: Articles were systematically searched from inception to February 18, 2025, using four English databases and three Chinese databases. Keywords and Medical Subject Headings were used to identify potential studies written in both Chinese and English. This study was performed using the Joanna Briggs Institute qualitative systematic review methodology.
    RESULTS: Twenty-five articles were included in this review. Guided by the Theoretical Domains Framework (TDF), eight synthesised findings were extracted, focusing on the representation of factors influencing the adherence of patients with cancer to prehabilitation, including the domains of knowledge (two facilitators), reinforcement (two facilitators), beliefs about consequences (two facilitators), beliefs about capabilities (two barriers), environmental context and resources (two barriers, one intervention preference factor), social influence (one facilitator, one intervention preference factor), emotion (one barrier, one facilitator) and behavioural regulation (one facilitators, two intervention preference factors).
    CONCLUSION: Our findings indicate that the adherence to prehabilitation among patients with cancer is shaped by a dynamic interplay of determinants. Structured assessments, self-monitoring, tailored interventions and tele-prehabilitation can improve patients' self-efficacy, perceived benefits and access to resources, which in turn can facilitate their completion of prehabilitation.
    IMPACT: This study deepens our understanding of behaviours related to adherence to prehabilitation among patients with cancer and provides valuable guidance for the formulation and optimisation of subsequent prehabilitation intervention programmes.
    REPORTING: ENTREQ.
    PATIENT OR PUBLIC CONTRIBUTION: No patient or public contributions.
    TRIAL REGISTRATION: PROSPERO CRD: 42024553972.
    Keywords:  cancer; meta‐aggregation; prehabilitation; qualitative study; review
    DOI:  https://doi.org/10.1111/jocn.17853
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