bims-rebome 2026-05-10 papers

Adv Radiat Oncol. 2026 Jun;11(6): 102033

Risk Factors for Vertebral Compression Fracture Following Spine Stereotactic Body Radiation Therapy.

Suchet Taori, Samuel Adida, Shovan Bhatia, James C Bayley, Pascal O Zinn, Steven A Burton, John C Flickinger, Roberta K Sefcik, Peter C Gerszten.

Purpose: Vertebral compression fractures (VCFs) are potential complications following spine stereotactic body radiation therapy (SBRT). However, limited data exist on prognostic factors underlying VCF development following SBRT. The objective of this clinical cohort investigation was to evaluate risk factors for VCF development, VCF type (de novo or progressive), and VCF severity, following SBRT for spinal metastases.
Methods and Materials: A retrospective analysis was performed on a prospectively maintained database of 600 SBRT treatments (779 vertebral segments) for spinal metastases from 2002 to 2024. Exclusion criteria consisted of benign tumors, prior lesion-specific surgical intervention, and <1 month of follow-up. Logistic regression and Fine-Gray subdistribution hazard modeling was performed to evaluate predictors of VCF development.
Results: The median follow-up was 8 months (range, 1-251 months). Fifty-seven (10%) VCFs were identified following SBRT: 29 (5%) de novo VCFs and 28 (5%) progressive VCFs. The median time-to-VCF was 6 months (range, 1-83 months). The 1- and 3-year cumulative incidence of VCF was 11% (95% CI, 8.1%-15%) and 21% (95% CI, 15%-27%), respectively. On multivariable analysis, female sex (odds ratio [OR], 1.06; 95% CI, 1.02-1.11; P = .007), lumbar lesions (OR, 1.05; 95% CI, 1.00-1.11; P = .049), and pre-existing VCF (OR, 1.01; 95% CI, 1.00-1.02; P = .009) were significantly associated with any VCF development, whereas a greater Spinal Instability Neoplastic Scores (SINS) at SBRT trended toward significance (OR, 1.07; 95% CI, 1.00-1.14; P = .060). Osteolytic disease (OR, 1.04; 95% CI, 1.00-1.07; P = .042) and epidural tumor extension (OR, 1.04; 95% CI, 1.01-1.07; P = .022) were associated with de novo VCF development, whereas only pre-existing VCF (OR, 1.08; 95% CI, 1.04-1.12; P < .001) was significantly associated with progressive VCF development. Thirty-three (58%) VCFs required subsequent surgical stabilization. On multivariable analysis, lumbar lesions (OR, 1.07; 95% CI, 1.02-1.12; P = .004), pre-existing VCF (OR, 1.07; 95% CI, 1.01-1.13; P = .026), and a greater SINS at SBRT (OR, 1.02; 95% CI, 1.01-1.02; P = .002) were significantly associated with VCFs requiring stabilization.
Conclusions: This large clinical cohort investigation successfully identified patient subgroups with increased risks of developing VCFs following spine SBRT for metastatic disease. Identifying these at-risk subpopulations may guide additional follow-up surveillance and consideration of individualized discussions regarding potential conservative or stabilization management approaches, particularly for those patients with multiple underlying risk factors.

DOI: https://doi.org/10.1016/j.adro.2026.102033

JB JS Open Access. 2026 Apr-Jun;11(2):pii: e26.00069. [Epub ahead of print]11(2):

Biomechanical and Computational Modeling of Metastatic Acetabular Defects: Influence of Tumor Location on the Risk of Fracture.

Jacob Doddridge, Hongjia He, Rui Yang, E U Conrad, Nicholas Dunbar.

Background: Metastatic bone disease can lead to pathologic fracture of the pelvis which affects quality of life. There are limited validated approaches for biomechanical modeling, classification, or surgical treatment of metastatic acetabular defects.
Methods: An artificial hemipelvis bone was used to calibrate a computed tomography-based computational model of the pelvis with varying locations and sizes of acetabular defects. Metastatic defects affecting the anterior and posterior column, medial wall, and their combinations were created. Mechanical testing was performed on each defect, and images of the lateral surface of the acetabulum were analyzed by digital image correlation to measure peak surface strains. Finite element models were calibrated to match the measured peak surface strains. Pelvic stress during acetabular loading was predicted at the (1) medial wall, (2) superior acetabular region, (3) anterior, and (4) posterior columns. Acetabular regions with the highest risk for fracture based on margin of safety were identified by the defect type.
Results: The predicted surface strains were strongly correlated (R 2 = 0.95) with the biomechanical testing results, with a mean error of 0.14 ± 0.12 mε. Combined posterior column and medial wall defects had the highest surface strain and resulted in decreased margins of safety by 66% in the superior acetabular region and 86% in the anterior column. Across all single-region defects, the posterior column defect was the most at-risk for fracture, with a margin of safety reduction of 63% in the medial wall.
Conclusions: Pelvic fragility resulting from metastatic lesions was sensitive to the periacetabular defect location. Combined posterior column and medial wall defects caused the greatest compromise to pelvic structural integrity, with the superior acetabular region and medial wall identified as the most critical locations for pelvic fracture. These findings influence surgical decision-making by identifying posterior column and medial wall lesions as high-risk patterns that may require earlier prophylactic stabilization.
Level of Evidence: Level V. See Instructions for Authors for a complete description of levels of evidence.

DOI: https://doi.org/10.2106/JBJS.OA.26.00069

Ann Biomed Eng. 2026 May 04.

Femur Fracture Risk Assessment in Patients with Lytic Metastases Using CT-Based Finite Element Models and Bone Crack Simulations Technique.

Davide Bentivoglio, Cristina Curreli, Barbara Dozza, Anna Mammone, Elisa Bruatto, Laura Campanacci, Antonino Amedeo La Mattina.

PURPOSE: Femoral bone metastases represent a frequent and severe complication in patients with advanced solid tumours. Although fracture risk assessment commonly relies on Mirels' score, its limited specificity often leads to unnecessary surgical interventions. Patient-specific finite element (FE) models have shown improved accuracy; however, current approaches vary widely in methodology and rarely capture the full fracture process. This study investigates for the first time the application of a linear FE approach based on an incremental element deletion technique to simulate both fracture initiation and propagation in femurs with lytic metastases.
METHODS: Twenty-four patients with femoral lytic lesions were retrospectively analyzed, and model outcomes were compared with clinical results. The proposed approach was evaluated for its ability to stratify patients according to pathological fracture risk, in comparison with conventional simulation methods and the clinically accepted Mirels' score. In addition, a new failure threshold parameter derived from the work required to fracture the femur was investigated.
RESULTS: The simulations successfully replicated clinically observed fracture paths and demonstrated strong capability in differentiating high- and low-risk patients. The failure criterion based on the last applied load during simulated crack propagation provided the highest diagnostic performance, achieving excellent sensitivity and specificity. The fracture initiation parameter showed comparable performance, while the work-based parameter appeared more affected by variability in femur visibility.
CONCLUSION: The proposed modeling framework offers the advantage of predicting fracture paths, providing clinically valuable insight, and represents a further step toward improved stratification methods for the clinical management of femoral metastases.

Keywords: Crack propagation; Elements deactivation; Femoral bone metastases; Patient-specific finite element models

DOI: https://doi.org/10.1007/s10439-026-04144-3

Spine (Phila Pa 1976). 2026 Apr 22.

Revisiting Survival in the Treatment of Spinal Metastases from Lung Cancer in the Modern Era of Immunotherapy and Molecular Targeted Treatment (2017-2022).

Brendan M Striano, Marco L Ferrone, Kaitlyn E Holly, Christy Zheng, Andrew Nguyen, Joseph Macksood, Amelia Osgood, Joshua M Coan, J Prescott Chan, Patrick K Cronin, Daniel G Tobert, Andrew J Schoenfeld.

STUDY DESIGN: Retrospective cohort.
OBJECTIVE: To assess survival among patients with spinal metastases from lung cancer treated over a time period that accounts for advances in immunotherapy and targeted treatments.
SUMMARY OF BACKGROUND DATA: The use of immunotherapy and targeted treatments has improved survival for patients with lung cancer, questioning whether secular trends have ushered in a new landscape in the field of spinal metastases.
METHODS: We identified patients who underwent operative or non-operative treatment for spinal metastases (2017-22). The primary outcome was one-year survival. We used multivariable logistic regression analysis to adjust for confounders, including all variables abstracted as co-variates based on conceptual model. We also assessed for interactions between lung cancer and surgical intervention and surgical intervention and immunotherapy.
RESULTS: We included 997 patients, with 228 (22.9%) possessing a primary lung cancer diagnosis. At one year, lung cancer was significantly associated with the odds of mortality (OR 2.01; 95% CI 1.44, 2.82). Surgical intervention (OR 0.70; 95% CI 0.53, 0.92), serum albumin of 3.5 g/dL or greater (OR 0.34; 95% CI 0.24, 0.47) and ambulatory status (OR 0.47; 95% CI 0.34, 0.64) were all significantly associated with reduced likelihood of mortality. There was no significant association between immunotherapy and one-year survival (OR 0.82; 95% CI 0.61, 1.11; P=0.19). At 30- (OR 0.55; 95% CI 0.29, 0.98) and 90-days (OR 0.65; 95% CI 0.45, 0.93) immunotherapy was significantly associated with survival.
CONCLUSIONS AND RELEVANCE: One-year survival in the cohort of patients with spinal metastases derived from lung cancer was significantly lower than that of metastases from other cancers. Surgical intervention did not mitigate this fact. Immunotherapy may exert an effect on near-term survival only. The signals for some of these temporal changes are robust enough to warrant consideration of their impact on traditional prognostic utilities in the future.
LEVEL OF EVIDENCE: III.

Keywords: albumin; ambulatory status; immunotherapy; lung cancer; spinal metastases; surgery; survival

DOI: https://doi.org/10.1097/BRS.0000000000005723

Nat Rev Clin Oncol. 2026 May 05.

The transformative role of SBRT in the management of spinal metastases.

K Liang Zeng, Pejman Jabehdar Maralani, Michael Hardisty, Hanbo Chen, Jay Detsky, Deepak Dinakaran, Hany Soliman, Chia-Lin Tseng, Jeremie Larouche, Jetan Badhiwala, Elizabeth David, Katarzyna J Jerzak, Amit Singnurkar, Chris Heyn, Cari Whyne, Mark Ruschin, Arjun Sahgal.

Spinal metastases can cause disabling pain and neurological deterioration and have historically been treated with palliative intent and conventional external beam radiotherapy (cEBRT). A fundamental shift away from the short-term palliative goals associated with cEBRT has taken place over the past two decades following the availability of stereotactic body radiotherapy (SBRT). This technique has enabled durable pain relief and local control owing to the ability to precisely deliver high radiation doses across typically up to five fractions, with level 1 evidence supporting superior complete pain response rates and local tumour control compared with cEBRT. The development of spinal SBRT has also resulted in greater multidisciplinary collaboration, with neuroradiologists, spinal surgeons, interventional radiologists, biomechanical engineers, medical physicists, medical oncologists and radiation oncologists working together with the common goal of improving our understanding of the pathophysiology and treatment of spinal metastases. As a result, substantial gains have been realized in refining patient selection and treatment sequencing, and particularly the development of less-invasive surgical procedures. In this Review, we summarize the development and role of SBRT in the management of spinal metastases.

DOI: https://doi.org/10.1038/s41571-026-01152-z