bims-rebome 2026-04-26 papers

Arch Bone Jt Surg. 2026 ;14(1): 60-71

Quality Of Life and Functional Outcomes in Patients with Spinal Metastatic Bone Disease: A Retrospective Observational Study.

Muhammad Yafidy, Achmad Fauzi Kamal.

Objectives: Spinal tumors account for 6-8% of all bone tumors, with spinal metastatic bone disease being the most commonly found spinal tumor. Patients with spinal metastatic bone disease typically present with symptoms such as pain, neurological impairments, and potential paralysis. The morbidity associated with spinal metastatic bone disease significantly impacts the patients' quality of life. This study aims to investigate the outcomes of quality of life and functional outcomes in patients with spinal metastatic bone disease.
Methods: A retrospective observational study was conducted involving patients with spinal metastatic bone disease treated at Dr. Cipto Mangunkusumo Hospital from January 2021 to December 2023. The functional outcomes in this study were assessed using the Short Form-36 (SF-36) and the Oswestry Disability Index (ODI).
Results: A total of 73 patients were included in this study, with breast cancer being the most common primary tumor (53%). Significant associations were found between gender and pain component (P = 0.045) and general health component (P = 0.047) of SF-36 scores. Significant differences were also observed in SF-36 components - physical functioning (P = 0.046, r = -0.562), energy/fatigue (P = 0.035, r = -0.621), and general health (P = 0.027, r = -0.513) with age. Significant differences were observed between pre-therapy and post-therapy in SF-36 scores for physical functioning, role limitations due to physical health, energy/fatigue, pain, general health, and ODI. Post-surgery, SF-36 role limitations due to physical health and ODI scores showed significant improvement. No significant relationships were found between pain severity, extremity weakness, type of therapy, and SF-36 or ODI scores.
Conclusion: There are significant associations between gender, age, and functional outcomes in patients with spinal metastatic bone disease. There is improvement in SF-36 scores and ODI scores post-therapy, especially after surgery.

Keywords: Oswestry disability index; SF-36; Spinal metastatic bone disease

DOI: https://doi.org/10.22038/ABJS.2025.82413.3758

J Radiosurg SBRT. 2026 ;10(1-2): 75-84

Magnetic resonance-guided Linac for stereotactic body radiotherapy of spinal metastases.

Yutaka Natsuaki, Benjamin P Ziemer.

Spinal metastases are a common and challenging complication in oncology, often leading to significant morbidity. Advances in surgery and radiotherapy for primary cancers have markedly improved overall patient survival leading to increased chances of metastatic disease spread, and thus increasing the need for less invasive, personalized treatment strategies if this arises. Stereotactic body radiotherapy (SBRT) has emerged as a standard-of-care modality, providing durable local control; however, the proximity of tumors to spinal cord and other critical neural structures necessitates exceptional precision in targeting and dose delivery. Linear accelerators guided by magnetic resonance (MR) represent a major technological advancement by combining high-resolution soft tissue imaging with real-time adaptive radiotherapy. These systems enable superior visualization compared to computed tomography scans normally used in radiotherapy, daily plan adaptation, and intra-fraction motion management beyond the capabilities of conventional image guidance. This review explains the clinical rationale for MR-guided SBRT in spinal metastases, the technological foundations of MR-Linac systems, clinical workflows, and early outcome data using this technology. Special attention is given to challenges specific to spinal applications, such as MR imaging artifacts caused by spinal instrumentation. Established MR metal artifact reduction techniques and emerging artifact reduction methods based on artificial intelligence are discussed as potential solutions to improve image quality. While early results are promising, further development is needed in integrating advanced imaging modality technologies, beam delivery, workflow optimization, and clinical validation. MR-Linac SBRT offers a transformative approach to personalized, high-precision radiotherapy and has the potential to refine the standard of care for spinal metastases.

Keywords: MR-Linac; adaptive radiotherapy; real-time imaging; spinal metastases; stereotactic radiosurgery

Cureus. 2026 Mar;18(3): e105473

Prognostic Models for Patient Selection in Palliative Bone Radiotherapy: A Systematic Review.

Filipa A Martins, Nádia Brito, Domingos Sousa.

Palliative radiotherapy is a well-established treatment for symptomatic bone metastases, but patients with a vital prognosis of under 3 months may not experience benefit, making accurate prognostic estimation essential for treatment selection. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review of PubMed, Scopus, and Web of Science identified studies evaluating prognostic models in patients receiving bone metastases palliative radiotherapy. The risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). Nineteen studies were included, most retrospective and heterogeneous, with mixed primary tumour histology. A broad range of prognostic approaches was identified, including established scores, newly developed prognostic tools, validated models, and individual prognostic factors. Performance status was the strongest prognostic variable. Models found were heterogeneous, and most studies had a high or unclear risk of bias. This PRISMA review highlights that prognostic models may support patient selection for palliative radiotherapy, but given the heterogeneity of patients and clinical settings, their use requires robust external validation and should be adequate to the local context, clinician experience, and patient characteristics.

Keywords: bone metastases; palliative radiotherapy; prognostic models; survival prediction; systematic review

DOI: https://doi.org/10.7759/cureus.105473

Pract Radiat Oncol. 2026 Apr 18. pii: S1879-8500(26)00115-3. [Epub ahead of print]

Stereotactic Body Radiation Therapy for Non-Spine Bone Metastases: A Case-Based Radiosurgery Society Review.

PURPOSE: Growing evidence supports stereotactic body radiation therapy (SBRT) over conventional radiation therapy for spine bone metastases, with an expanding role in non-spine bone metastases (NSBM). Our case-based review aims to inform radiation oncologists in the appropriate utilization of SBRT for representative cases of NSBM.
METHODS AND MATERIALS: Three cases were selected for discussion: (1) rib, (2) skull base, and (3) femur. Relevant literature was reviewed, and areas for future investigation were discussed.
RESULTS: SBRT can be effectively delivered in NSBM with appropriate patient selection, target volume delineation, prescription dose, organs at risk dose constraints, and treatment planning.
CONCLUSIONS: The Radiosurgery Society's case-based review offers guidance on the appropriate use of SBRT in NSBM with discussions and consensus recommendations from experts. SBRT can be considered for an oligometastatic patient with favorable prognosis in whom the goal is durable local control and/or symptom relief. It can be considered for radioresistant histologies and improved OAR sparing. Available MRI or PET/CT should be fused to improve target volume delineation. A CTV margin, generally of 5 mm, should be considered to cover microscopic disease. As bones are easily visualized on daily images acquired for accurate and precise set-up of patients, a PTV margin should be kept less than or equal to 3 mm. While SBRT can be delivered in 1 fraction, fractionated SBRT may be preferred to meet dose constraints when the CTV is adjacent to the OARs. NSBM of long bones that are weight bearing, lytic, or have a high MIRELS score should be evaluated by an orthopedic surgeon.

DOI: https://doi.org/10.1016/j.prro.2026.04.004

J Bone Joint Surg Am. 2026 Apr 22.

Development of a Radiographic Scoring System to Estimate Acetabular Protrusion Risk in Patients with Osteolytic Periacetabular Metastases.

Will Jiang, Donghao Gan, Steven Tommasini, Igor Y Latich, Dieter Lindskog, Francis Y Lee.

BACKGROUND: For patients with periacetabular metastases, protrusio acetabuli is a severely painful and mobility-impairing complication that requires subsequent open joint surgery. We aimed to identify specific structural changes that are associated with progression to protrusio acetabuli and to create a scoring system to guide risk stratification.
METHODS: In this single-institution cohort study, we identified all patients who underwent primary surgical stabilization for periacetabular metastases with osteolytic or mixed osteolytic-osteoblastic characteristics from October 2017 through January 2025. Cases of protrusio acetabuli prior to surgical intervention were identified. Pain and ambulatory functional scores and treatment history were recorded. Locations of bone destruction were evaluated using coronal-cut computed tomography (CT) scans obtained within 3 months before clinical presentation (and earlier, as available). Trabecular and subchondral cortical bone mass of the periacetabular weight-bearing portions were indirectly assessed via Hounsfield unit ratio comparisons across scans. Univariable analysis of each feature was performed. The highest-scoring features were used to create a scoring system and analyzed using a receiver operating characteristic (ROC) curve. Finite element analysis was performed for biomechanical validation.
RESULTS: Eighty-seven patients (67 non-protrusio [mean age of 65.5 ± 13.0 years; 37 female]; 20 protrusio [mean age of 72.9 ± 10.1 years; 11 female]) were included. Locationally, bone defects, thinning, or linear fractures in the middle-third (apex) alongside contiguous involvement of either the medial- or lateral-third of the weight-bearing dome were highly predictive of protrusio. A >50% cortical bone-mass decrease of the acetabular weight-bearing dome was associated with protrusio (p < 0.05). A radiographic risk scoring system was then constructed using a grading system from low- to high-risk features. ROC analysis showed a score of ≥3.0 as 95.0% sensitive and 91.0% specific for progression to protrusio. Finite element analysis further showed that cortical bone loss of the middle-third (apex) of the weight-bearing dome was critical.
CONCLUSIONS: We propose the use of clinical and radiographic risk predictors to stratify patients with periacetabular metastases on the basis of the risk of protrusio. Anatomically, surgical stabilization of the middle-third (apex) of the weight-bearing dome is critical to preventing or delaying progression to protrusio.
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

DOI: https://doi.org/10.2106/JBJS.25.01219

Acta Orthop Belg. 2026 Apr 20. 92(1):

Beyond the Field of View: Enhancing Detection of Orthopaedic Metastases in Cancer Staging.

A Malouhi, C Spiegel, F Weschenfelder, K G Schrenk, G O Hofmann, W Weschenfelder.

The rising prevalence of metastatic bone disease (MBD), driven by improved oncological survival, places increasing demands on accurate staging. Standard computed tomography of the chest, abdomen, and pelvis (CT-CAP) often may fail to identify orthopaedically relevant lesions, which may contribute to pathological fractures and poorer outcomes. A retrospective single-centre review was conducted of 135 patients who underwent surgery for non- spinal MBD between 2005 and 2024. Preoperative staging imaging was re-evaluated to assess lesion visibility, anatomical distribution, and detection rates across modalities. Lesions were analysed with respect to fracture occurrence, Mirels scores, and postoperative survival. Interobserver agreement for Mirels scoring was calculated. Survival was analysed using Kaplan-Meier methods and a multivariate Cox proportional hazards model. Lesions not identified on staging imaging were associated with significantly higher rates of pathological fracture (p = 0.01) and shorter postoperative survival (median 6 vs. 25 months, p = 0.03). CT-CAP detected fewer orthopaedically relevant lesions than alternative imaging modalities in this retrospective real-world cohort (p < 0.01). Seven clinically relevant lesions were visible only on CT scout images but lay outside the diagnostic field of view; four subsequently fractured. Detection varied by anatomical region, with proximal femoral lesions identified most frequently. In this retrospective cohort, reliance on CT-CAP alone was associated with missed clinically significant MBD lesions, particularly outside the standard field of view. Routine review of full-body scout images may improve detection and potentially reduce preventable fractures. Integration of automated analysis techniques could further strengthen diagnostic accuracy.

DOI: https://doi.org/10.52628/92.1.15095