bims-rebome 2026-05-17 papers

Eur J Cancer. 2026 May 04. pii: S0959-8049(26)00564-2. [Epub ahead of print]241 116783

Standardising definitions, endpoints, and reporting parameters for clinical studies of stereotactic body radiation therapy in bone metastases: An international Delphi consensus.

BACKGROUND: Stereotactic body radiation therapy (SBRT) is increasingly used for bone metastases, but inconsistent endpoint definitions and reporting hinder evidence synthesis and clinical application. This study aimed to establish international consensus recommendations for standardised endpoints, definitions, and reporting parameters in SBRT studies for bone metastases.
METHODS: A systematic review of prospective SBRT studies (2014-2024) informed a three-round modified Delphi consensus process conducted from 2024 to 2025. Consensus was predefined as at least 75% agreement. Candidate items were refined through iterative online surveys, qualitative feedback, and a final prioritisation vote by an international multidisciplinary expert panel.
RESULTS: Of 114 invited experts, 82 from 20 countries participated in at least one Delphi round. Review of 58 prospective studies showed substantial variability in endpoint definitions, pain and toxicity assessment, radiological response criteria, and timing of outcome evaluation. The panel endorsed 46 reporting items (41 required, 5 recommended) and prioritised core endpoint sets across three clinical contexts: oligometastatic, oligoprogressive, and asymptomatic high-risk bone metastases. Strong consensus was reached for definitions of vertebral compression fracture (92%), time to salvage local therapy (93%), duration of pain response (92%), and time to local progression (90%); pain flare achieved 89% agreement. A revised clinical response framework (C-BRAC), introducing a stable disease category, achieved 91% agreement and was recommended for exploratory use alongside existing criteria.
CONCLUSIONS: These recommendations provide a structured framework for designing and reporting SBRT studies in bone metastases and may improve consistency, comparability, and future guideline development.

Keywords: Bone metastases; Clinical trial reporting; Delphi consensus; Endpoints; Standardisation; Stereotactic body radiation therapy

DOI: https://doi.org/10.1016/j.ejca.2026.116783

Joint Bone Spine. 2026 May 12. pii: S1297-319X(26)00045-X. [Epub ahead of print] 106076

Interventional radiology in bone metastases: current concepts and perspectives.

Nicolas Stacoffe, Emmanuel Mesny, Mathilde Proriol, Aurélie Fontana, Bastien Chalamet, Mohamed-Ilyess BenRejeb, Edith Bonnelye, Jean-Baptiste Pialat, Cyrille Confavreux, Emmanuel Massy.

The skeleton is a frequent site of metastatic spread, leading to skeletal-related events (SREs) such as pathological fractures, spinal cord compression, and refractory pain that profoundly impact patient survival and quality of life. Traditionally managed by a triad of radiotherapy, surgery, and systemic treatments, the landscape of bone metastasis care has undergone a major paradigm shift. Interventional Radiology (IR) has emerged as the "fourth pillar" of oncology, evolving from a palliative last-resort tool into a proactive specialty integrated into precision medicine and multidisciplinary decision-making. Through high-resolution image guidance, IR provides critical diagnostic tissue sampling for molecular profiling, immediate mechanical reinforcement via hybrid stabilization-combining percutaneous osteosynthesis and cementoplasty-and local tumor control through thermal ablation and cryoablation. Beyond its mechanical and local effects, an emerging body of research highlights the immunomodulatory potential of cryoablation and thermablation technics. IR-induced tumor necrosis may act as a potent "in situ" vaccine, releasing tumor-associated antigens and damage-associated molecular patterns that could trigger a systemic abscopal effect, especially when synergistic with immune checkpoint inhibitors. This review details the state-of-the-art IR techniques, from devascularization via embolization to advanced cryoablation, emphasizing their strategic integration into modern care pathways. It highlights the transition from simple symptom management to aggressive, curative-intent strategies in the era of personalized oncology, where IR serves as a bridge between conservative medical therapy and invasive surgical intervention.

Keywords: Bone metastases; Cementoplasty; Cone-beam CT guidance (CBCT); Interventional oncology; Thermal ablation

DOI: https://doi.org/10.1016/j.jbspin.2026.106076

Jpn J Clin Oncol. 2026 May 12. pii: hyag074. [Epub ahead of print]

Clinical utility of tumour markers in skeletal metastasis of unknown primary at the initial visit.

Kensaku Yamaga, Keiichi Akahori, Mari Osaki, Hideki Nagashima.

BACKGROUND: Skeletal metastasis of unknown primary at the initial visit represents a clinically important subset of metastatic bone tumours, accounting for ~7.8%-21.7% of all skeletal metastases. This condition differs from cancer of unknown primary (CUP), in which the primary site remains unidentified after comprehensive evaluation. At this diagnostic entry point, before completion of a full work-up, early stratification is essential; however, the clinical utility of serum tumour markers at this stage remains unclear.
METHODS: We retrospectively reviewed 79 patients who presented with skeletal metastasis of unknown primary at the initial visit before diagnostic work-up between January 2010 and October 2023. Clinical characteristics, final primary diagnoses, types of tumour markers measured, positivity rates, and diagnostic performance were analysed.
RESULTS: Haematologic malignancies were the most frequent final diagnoses (40.5%), followed by lung (22.8%) and prostate cancer (10.1%). A total of 17 tumour markers were measured (mean, 6.3 per patient; range, 0-12). Prostate-specific antigen (PSA), immunoelectrophoresis (IEP), soluble interleukin-2 receptor (sIL-2R), and thyroglobulin (Tg) showed high sensitivity and specificity for prostate cancer, multiple myeloma, malignant lymphoma, and thyroid cancer, respectively. Carcinoembryonic antigen (CEA) and cytokeratin 19 (CK19, CYFRA 21-1), although not organ-specific, were frequently positive in carcinomas and served as indicators of epithelial malignancy.
CONCLUSIONS: Serum tumour markers can assist early diagnostic stratification at the initial presentation of skeletal metastasis before primary-site identification. A selective testing strategy focusing on sIL-2R, IEP, CEA, and CK19, with PSA added in men and Tg when clinically indicated, may improve diagnostic efficiency and provide a basis for considering a bone-metastasis-oriented diagnostic approach.

Keywords: bone metastasis; diagnostic strategy; early diagnosis; immunoelectrophoresis; skeletal metastasis of unknown primary; soluble interleukin-2 receptor; tumour markers

DOI: https://doi.org/10.1093/jjco/hyag074