bims-rebome 2026-06-14 papers

bims-rebome

Biomed News

on Management of bone metastases

Issue of 2026–06–14
fourteen papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata

Unplanned readmission after surgery for spinal metastases: The influence of data source on a surgical oncology quality indicator - A systematic review and descriptive meta-analysis.
Minimal clinically important differences in the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0) in patients with symptomatic spinal metastases.
Prediction of compressive strength of vertebral body with metastatic lesions based on quantitative computed tomography-based subject-specific finite element models.
Advancements in Skeletal Tumour Management: Linking Metastatic Biology With Surgical Reconstruction.
Predictive value of frailty indices for postoperative outcomes of metastatic spine tumor: a systematic review and meta-analysis.
Preoperative hypoalbuminemia predicts early complications, mortality, and discharge disposition following surgical resection of spinal metastases: a nationwide study.
Discharge health education needs and experiences of patients with skeletal-related events from bone metastases: A qualitative study.
Outcomes and Complications Associated With 191 Carbon Fiber Pedicle Screws in Spinal Oncology Patients.
Bone Fragility: Time to Address the Matrix.
Stereotactic body radiotherapy for non-spinal bone oligometastases: a mono-institutional experience.
Autoantibodies combined with systemic inflammation markers for predicting bone metastases in non-small cell lung cancer patients.
Mepilex Lite dressing in the management of radiation dermatitis-a systematic review and meta-analysis of randomized controlled trials.
Long-Term Results of a Comparison Between 15 × 2.633 Gy and 20 × 2.0 Gy for Malignant Spinal Cord Compression in Patients with Longer Expected Survival Times.
Efficacy and Safety of Electroacupuncture for Postoperative Insomnia in Patients With Spinal Metastasis: Protocol of a Prospective, Multicenter, Randomized Controlled Study.

Eur J Surg Oncol. 2026 Jun 09. pii: S0748-7983(26)00546-9. [Epub ahead of print]52(8): 111927

Unplanned readmission after surgery for spinal metastases: The influence of data source on a surgical oncology quality indicator - A systematic review and descriptive meta-analysis.

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

  Surgery for spinal metastases represents a complex intervention at the intersection of oncology, neurosurgery, and orthopaedics, performed in patients with advanced systemic disease and limited physiological reserve. Unplanned hospital readmission has emerged as an important quality indicator in surgical oncology, reflecting both perioperative care quality and the trajectory of underlying malignancy. We conducted the first systematic review and descriptive meta-analysis of readmission incidence and risk factors in this population. Five databases were searched (January 2010-March 2026); 14 cohort studies (8132 patients for 30-day analysis; 22,198 for 90-day analysis) met inclusion criteria. Given anticipated heterogeneity between institutional cohorts and national administrative databases, a stratified analytical framework was pre-specified. The exploratory pooled 30-day readmission incidence was 16.0% (95% CI: 12.2-20.3%; 95% prediction interval: 5.3-30.8%; I2 = 93.2%). Stratification revealed homogeneous estimates from single-centre studies (13.9%; I2 = 0%; k = 5) versus higher rates from administrative databases (20.4%; k = 2; p < 0.001), indicating that the data source is a principal driver of the observed heterogeneity. Pooled 90-day incidence was 31.2% (95% CI: 26.9-35.6%; k = 7). Comorbidity burden, prior spinal radiation, and poor functional status were the most consistently identified risk factors, although effect-measure heterogeneity precluded quantitative pooling. Evidence certainty was very low (GRADE). Approximately one in six cancer patients experiences unplanned readmission within 30 days of spinal metastasis surgery, with the wide prediction interval underscoring substantial setting-dependent variability. These findings support the integration of readmission tracking into spinal metastasis surgery quality programmes and prospective validation of risk-stratified perioperative pathways.

Keywords:  Cancer surgery; Quality indicator; Readmission; Spinal metastases; Surgical oncology; Systematic review

DOI:  https://doi.org/10.1016/j.ejso.2026.111927
Spine J. 2026 Jun 10. pii: S1529-9430(26)00155-5. [Epub ahead of print]

Minimal clinically important differences in the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0) in patients with symptomatic spinal metastases.

AO Spine Knowledge Forum tumor

   BACKGROUND CONTEXT: It is currently unknown what absolute change in Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0) represents a clinically meaningful change for a patient which causes challenges with the interpretation of the SOSGOQ2.0 total score or domain scores.
PURPOSE: The aim of this study was to determine the minimally clinically important difference (MCID) for the SOSGOQ2.0 in patients with spinal metastases.
STUDY DESIGN: An international multicenter prospective observational study by the AO Spine Knowledge Forum Tumor.
PATIENT SAMPLE: patients with spinal metastases who were treated with surgery and/or radiotherapy OUTCOME MEASURES: HRQOL was evaluated using the SOSGOQ2.0 at pre-defined time points METHODS: The MCID values for the SOSGOQ2.0 were determined using both distribution-based as well as anchor-based methods. For the anchor-based method, the post-therapy questions of the SOSGOQ2.0 served as the anchor with response options collapsed into "improvement", "no change" and "deterioration". Spearman correlation coefficients were calculated to identify post-therapy items with a correlation of ≥0.30 with the corresponding domain scores. MCID values from the distribution-based methods were derived using the statistical characteristics of the study population and compared to the anchor-based results.
RESULTS: A total of 317 patients had SOSGOQ2.0 data available at baseline and at 12 weeks post-treatment and were included in the final analyses. Anchor-based MCID values for improvement in the physical function, pain, mental health and social function domains were 10.2, 26.0, 14.4 and 17.2 respectively. Compared with the distribution-based approach, anchor-based MCIDs for improvement suggest that the patient-perceived improvement corresponds to a strong level of improvement.
CONCLUSIONS: This is the first study to report MCID values for the SOSGOQ2.0 total score and domain scores. The distribution-based MCID estimates will help both clinicians as well as researchers with the interpretation of the effect of treatment for painful spinal metastases on patient reported HRQOL.

Keywords:  MCID; minimal clinically important difference; minimally clinically important difference; patient reported outcomes; quality of life; radiotherapy; spinal metastases; surgery

DOI:  https://doi.org/10.1016/j.spinee.2026.05.007
Bone. 2026 Jun 06. pii: S8756-3282(26)00187-0. [Epub ahead of print]211 117961

Prediction of compressive strength of vertebral body with metastatic lesions based on quantitative computed tomography-based subject-specific finite element models.

Rajdeep Ghosh, Eddie Shearman, Robert Roger, Marco Palanca, Enrico Dall'Ara, Damien Lacroix.

  Pathologic vertebral fractures are a major complication in metastatic spine disease. However, current clinical scores, such as Spinal Instability Neoplastic Score (SINS), show limited predictive capability, particularly within the indeterminate range where most clinical uncertainty lies. This study aimed to develop and evaluate quantitative computed tomography (qCT)-based subject-specific finite element (SSFE) models to predict vertebral strength in presence of different metastatic lesion types. Twelve ex vivo human spine segments, each containing one metastatic (n = 12) and one adjacent control vertebra (n = 12), were scanned using qCT and calibrated using a calibration phantom. Homogenised nonlinear finite element models were developed with spatially heterogeneous, isotropic, density-dependent material properties and loaded under uniaxial compression corresponding to 1.9% apparent strain. Ultimate failure load, stiffness, and strain distributions were compared between metastatic and control vertebrae. Predicted failure load ranged from 0.2 kN to 6.2 kN (median (IQR): 1.10 (0.64-2.68) kN metastatic; 1.21 (0.69-2.84) kN control), with no statistically significant difference between groups (p > 0.05). Normalised failure load varied widely, reflecting lesion-specific mechanical heterogeneity. Lytic lesions generally weakened vertebrae, whereas mixed and blastic lesions occasionally enhanced strength, likely due to localised sclerosis or reactive bone formation. High compressive axial strains (greater than 0.019) were frequently concentrated near the endplates, particularly in lytic vertebrae. qCT-derived bone mineral density strongly correlated with failure load (R2 = 0.74-0.77). These findings highlight the complexity of metastatic vertebral mechanics and demonstrate that qCT-based SSFE modelling provides a quantitative framework for assessing fracture risk, complementing conventional imaging-based tools.

Keywords:  Bone strength; Digital twin; Finite element; Metastasis; Spine biomechanics; Vertebra

DOI:  https://doi.org/10.1016/j.bone.2026.117961
Cureus. 2026 May;18(5): e108278

Advancements in Skeletal Tumour Management: Linking Metastatic Biology With Surgical Reconstruction.

Eswara Reddy G, Shivakumar Ms, Sameer A Ansari, Manjunath A N, K Parameswaran Namboothiri, Syed F Hamid.

  Skeletal tumours, particularly metastatic bone disease, represent a significant clinical challenge due to their complex biological behaviour and impact on structural integrity and patient function, with improved cancer survival contributing to increased skeletal involvement requiring integrated management. The objective of this review is to examine the evolving relationship between metastatic biology and surgical reconstruction, with emphasis on translational insights for clinical decision-making. A structured narrative review was conducted using PubMed, Scopus, and Web of Science to identify literature published between 2015 and 2025, employing predefined search terms including "bone metastasis", "tumour microenvironment", "skeletal tumours", "MRI", "PET/CT", "radiomics", "targeted therapy", "immunotherapy", and "orthopaedic reconstruction". Studies were screened through title and abstract review followed by full-text assessment, with inclusion criteria prioritising peer-reviewed clinical studies, systematic reviews, and translational research relevant to molecular mechanisms, imaging, systemic therapies, and reconstructive strategies; methodological quality and relevance were appraised qualitatively, and findings were synthesised using a thematic integrative framework. Current evidence highlights tumour-bone interactions, including chemokine-mediated homing and RANK/RANKL pathway dysregulation, as key drivers of disease progression, while advances in imaging and radiomics improve diagnostic accuracy and prognostication; comparative analysis indicates that MRI provides superior local tumour delineation, whereas PET/CT enables assessment of metabolic activity and systemic disease burden, thereby informing surgical planning. Systemic therapies influence tumour biology and surgical timing, and innovations in endoprosthetic and biological reconstruction have expanded limb-salvage options. Key outcomes of this synthesis demonstrate that integrating molecular pathways, imaging-derived biomarkers, and treatment response parameters into surgical decision-making enhances prognostic stratification, optimises intervention timing, and improves functional outcomes, although heterogeneity in study design limits standardisation. This review moves beyond descriptive synthesis by providing a clinically oriented integrative framework linking metastatic biology, radiological phenotype, and reconstructive strategy selection, supporting personalised, multidisciplinary care and improved clinical outcomes in orthopaedic oncology.

Keywords:  bone metastasis; endoprosthesis; orthopaedic oncology; skeletal tumours; tumour microenvironment

DOI:  https://doi.org/10.7759/cureus.108278
J Orthop Surg Res. 2026 Jun 06.

Predictive value of frailty indices for postoperative outcomes of metastatic spine tumor: a systematic review and meta-analysis.

Hai-Bo Xie, Ling-Shan Fan, Qi Zhang, Xiao-Yu Zhang, Si Wu, Xiao-Qing Zhang, Kang-Jian Li, Ai-Feng Liu.

  Surgical management of spinal metastases aims to palliate symptoms but poses significant perioperative risks. Traditional tools like survival scores and comorbidity indices inadequately capture the multidimensional frailty in cancer patients, prompting interest in frailty indices for risk stratification. This meta-analysis evaluates the predictive value of frailty indices for postoperative outcomes in spinal metastasis surgery. Adhering to PRISMA guidelines, PubMed, Embase, Cochrane Library, and other databases were systematically searched until May 2025. Observational clinical studies reporting frailty indices and postoperative outcomes (complications, LOS, nonroutine discharge, and survival rate) in spinal metastasis surgery were included. Study quality was assessed via Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were calculated using fixed-effect model. A total of 12 studies involving 17,446 patients were included. The predictive value of several frailty indices, such as the 5-item/ 11-item modified frailty index (mFI-5/mFI-11), Metastatic Spinal Tumor Frailty Index (MSTFI), and Johns Hopkins Adjusted Clinical Groups (JHACG), were assessed. Some of the frailty indices predicted adverse outcomes: prolonged LOS (mFI-5 OR = 1.67, p = 0.014; JHACG OR = 2.65, p < 0.001), nonroutine discharge (MSTFI OR = 1.59, JHACG OR = 1.79; all p < 0.001), and complications (mFI-11 OR = 2.94, p = 0.003; MSTFI OR = 1.42, p < 0.001; JHACG OR = 1.54, p < 0.001). Survival prediction was inconsistent; only MSTFI correlated with 30-day mortality in one study (p < 0.05). Synthesized evidence from observational studies suggests that frailty indices were potential prognostic factors to predict post-operative morbidity, LOS, and discharge complexity. However, survival prognostication remains limited by tumor biology variability and methodological heterogeneity. Future efforts should integrate frailty assessments with tumor-specific factors to enhance prognostic precision and guide personalized perioperative optimization.

Keywords:  Evidence-based; Frailty index; Prediction value; Spinal metastasis

DOI:  https://doi.org/10.1186/s13018-026-06978-y
Eur Spine J. 2026 Jun 08.

Preoperative hypoalbuminemia predicts early complications, mortality, and discharge disposition following surgical resection of spinal metastases: a nationwide study.

Bibhas Amatya, Abdul Karim Ghaith, Lansaol Yang, Nadim Hamadeh, Mohamad Ghaith, Shahab A Sattari, Amna Hussein, Maher Ghandour, Nicholas Theodore, Daniel Lubelski.

   PURPOSE: Patients undergoing surgery for spinal metastases often have limited physiologic reserve. Although hypoalbuminemia is a recognized risk marker, its graded association with short-term postoperative outcomes and discharge disposition has not been well defined in large national cohorts. We evaluated the relationship between preoperative serum albumin and early postoperative outcomes following surgery for spinal metastases.
METHODS: Adults undergoing surgery for metastatic extradural spinal tumors (laminectomy or tumor excision with or without fusion) were identified in ACS-NSQIP (2010-2022). Hypoalbuminemia was defined as albumin < 3.5 g/dL and stratified as mild (3.0-3.49), moderate (2.5-2.99), or severe (< 2.5). Primary outcomes were any 30-day complication, 30-day mortality, and non-home discharge. Multivariable logistic regression adjusted for demographic, clinical, and operative factors. Exploratory machine-learning models assessed discrimination and variable importance.
RESULTS: Among 4,126 patients, 1,534 (37.2%) were hypoalbuminemic. Hypoalbuminemia was associated with higher rates of complications, mortality, non-home discharge, and longer hospitalization (all p < 0.001), with outcomes worsening stepwise across albumin strata. After adjustment, hypoalbuminemia independently predicted complications (OR 1.52), mortality (OR 2.73), and non-home discharge (OR 1.89) (all p < 0.001). Albumin ranked among the most influential predictors in machine-learning models.
CONCLUSION: Preoperative hypoalbuminemia shows a dose-dependent, independent association with early morbidity, mortality, and post-acute care needs after surgery for spinal metastases, supporting its use in perioperative risk stratification and care planning.

Keywords:  Hypoalbuminemia; Machine learning; NSQIP; Spinal metastases; Spine surgery

DOI:  https://doi.org/10.1007/s00586-026-10083-3
PLoS One. 2026 ;21(6): e0341790

Discharge health education needs and experiences of patients with skeletal-related events from bone metastases: A qualitative study.

Jing Shan, Shuangyan Wang, Fan Ding, Junli Liang, Jianxin Wang, Donglai Wang.

OBJECTIVE: To describe the health education needs and experiences of patients with skeletal-related events due to bone metastasis from solid tumours upon discharge and to provide a reference for the formulation of discharge health education plans for this population.
METHODS: A qualitative descriptive design and purposive sampling method were used to select patients with skeletal-related events due to bone metastasis from solid tumours who were hospitalized in the orthopaedic department of a Class III Grade A cancer hospital in Hebei Province from June to July 2024 for in-depth semistructured interviews. A Colaizzi 7-step analysis method was used to refine the themes of the patients' needs.
RESULTS: The needs of solid tumour bone metastasis patients with skeletal-related events for discharge health education provided by medical staff were refined into five themes: 1) bone health knowledge needs: patients were eager to obtain in-depth knowledge beyond the definition of the disease, such as the specific warning of pathological fracture and the early identification of bone metastasis progression; 2) bone health self-management needs: the focus was on specific operation guidance, including the home application of analgesic stepwise therapy and the protection skills for bone destruction sites; 3) coping with daily life needs: patients were concerned about how to safely go to the toilet, take a bath and other daily activities under the risk of disability; 4) coping with psychological pressure needs: manifested as the counselling needs for fear of disability and psychological support to combat the "burden feeling" during long-term pain; and 5) family and social support needs: patients need a collaborative nursing model that includes family participation, as well as a remote consultation channel for continuous access to professional medical care after discharge. Three themes were extracted from the information experience: 1) barriers to understanding medical terms: the professional words used by medical staff (such as "skeletal-related events" and "bone scan") confused patients, leading to incorrect interpretation or neglect of health education; 2) passive acceptance: patients were unable to obtain targeted information, and the existing education is mostly one-way indoctrination, which fails to consider the differences in personalized care after bone metastasis of different primary cancers (such as lung cancer, breast cancer and prostate cancer); and 3) the large amount of information leads to poor satisfaction: the large amount of fragmented data provided before discharge leads to information overload and cognitive fatigue among patients, and the actual mastery rate and application satisfaction after discharge are low.
CONCLUSIONS: Patients with skeletal-related events due to bone metastasis from solid tumours face challenges such as a lack of bone health knowledge, psychological distress and a lack of self-management ability when discharged from the hospital. Medical staff should formulate a personalized discharge health education plan according to the needs of patients.

DOI: https://doi.org/10.1371/journal.pone.0341790
Int J Spine Surg. 2026 Jun 09. pii: 8905. [Epub ahead of print]

Outcomes and Complications Associated With 191 Carbon Fiber Pedicle Screws in Spinal Oncology Patients.

Marcus Selles, Jonathan P Japa, Chukwuka Obiofuma, Lancelot Benn, Oliver Tannous, Kevin Yoon, Mark Ehioghae, Addisu Mesfin.

   BACKGROUND: Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation is used in spinal tumor surgery owing to its reduced artifact on postoperative imaging.
OBJECTIVE: To evaluate the outcomes and complications associated with the use of CFR-PEEK instrumentation.
METHODS: This case series reviews 35 patients who underwent surgery using CFR-PEEK instrumentation between December 2020 and April 2025 at 2 academic institutions. Variables collected included demographics, cancer type, tumor location, tumor histology, surgical technique (open vs minimally invasive), and mortality at the latest follow-up. Categorical variables were described with frequencies, while continuous variables were described with means and SDs.
RESULTS: Thirty-five patients underwent 36 CFR-PEEK instrumentation procedures, utilizing a total of 191 screws. Patients had a mean age of 60.97 years (range: 15-83 years), and 23 patients (65.7%) were men. Thirty-one patients (88.6%) had metastatic spine tumors, with most tumors affecting the thoracic spine (51.4%). The most common histologies were multiple myeloma (n = 5) and lung cancer (n = 5). Twenty-two (66.6%) patients had a pathological fracture, while 16 (45.71%) had spinal cord compression on initial presentation. The mean estimated blood loss was 547.1 mL (range: 70-2000 mL). There were 1 intraoperative and 6 postoperative complications. One surgical revision was necessary due to a symptomatic screw. Median follow-up time was 5 months. The mortality rate at the latest follow-up was 40% (n = 14).
CONCLUSION: Our experience with CFR-PEEK implants demonstrates outcomes comparable to titanium implants. While CFR-PEEK facilitates the detection of local recurrences more quickly, long-term, large-scale studies are necessary to assess its cost-effectiveness.
CLINICAL RELEVANCE: This case series describes the use of carbon fiber instrumentation in patients with spinal tumors and encourages future studies to compare it with other instrumentation methods.
LEVEL OF EVIDENCE: 4:

Keywords:  CFR-PEEK; carbon fiber; oncology; spinal metastasis; spine surgery; tumor

DOI:  https://doi.org/10.14444/8905
J Bone Miner Res. 2026 Jun 09. pii: zjag094. [Epub ahead of print]

Bone Fragility: Time to Address the Matrix.

Samuel J Stephen, Joy Y Wu, Christopher J Hernandez.

  Mechanical failure of bone - not bone density - is the primary clinical concern for skeletal disorders and diseases. Bone mass and density are major contributors to whole bone strength, which is why therapeutics that regulate bone volume by altering resorption and formation are so effective. However, there are limits to the increases in bone mass and density achieved with existing therapeutics and challenges in maintaining gains after treatment is suspended. This perspective focuses on a major contributor to whole bone strength that is not directly addressed by existing therapeutics: the quality of bone extracellular matrix as measured by matrix mechanical properties. We review studies showing: a) whole bone strength is much more sensitive to variation in bone matrix quality than to bone mass/density, b) bone matrix quality varies in humans in ways sufficient to influence whole bone strength, and c) interventions may alter bone matrix quality with minimal effects on bone mass/density. A major limitation to discovering methods for improving bone matrix quality is that most preclinical studies focus on bone formation and bone density/mass and do not measure or report bone matrix mechanical properties. Identifying mechanisms that enhance bone matrix quality will require faster and more precise biomechanical assessments of bone matrix and studies specifying the molecular mechanisms that regulate the composition of bone extracellular matrix. While there are many observational reports of differences in bone matrix among individuals, here we argue it is time to go beyond observational studies and consider bone matrix as an attractive therapeutic target.

Keywords:  Aging; Analysis of Bone; Bone Matrix; Osteocytes; Preclinical Models

DOI:  https://doi.org/10.1093/jbmr/zjag094
Clin Transl Oncol. 2026 Jun 06.

Stereotactic body radiotherapy for non-spinal bone oligometastases: a mono-institutional experience.

Francesco Cuccia, Gianluca Mortellaro, Marina Campione, Daniela Cespuglio, Salvatore D'Alessandro, Vanessa Figlia, Antonio Spera, Francesco Azzarello, Carlo Messina, Livio Blasi, Giuseppe Carruba, Giuseppe Ferrera.

   BACKGROUND: Stereotactic body radiotherapy (SBRT) has entered daily clinical practice in the management of oligometastatic disease. Similarly to the evidence in support of spinal metastases, the use of SBRT has been recently reported also for the treatment of non-spinal bone metastases (NSBM).
METHODS: This is a single-institutional experience of oligometastatic patients treated with SBRT for NSBM. Oligometastases were defined according to the recent ESTRO/EORTC consensus. Inclusion criteria were as follows: ECOG PS ≤ 2, written informed consent, up to 5 lesions to be treated at the same time, and treatment with radiotherapy schedules applying a minimum of 6 Gy per fraction. The primary endpoint of the study was local control (LC); acute and late toxicity, distant progression-free survival (DPFS), time-to-next systemic treatment (TNST), and overall survival (OS) were secondary endpoints. Toxicity was assessed according to CTCAE criteria v5.0. Survival estimates were performed using the Kaplan-Meier method, uni- and multi-variate analyses were carried out to identify any potentially significant correlation.
RESULTS: A total of 74 bone oligometastases in 52 patients were treated in our institution between February 2020 and December 2024. All patients received SBRT with Helical Tomotherapy for a median total dose of 33.7 Gy (range, 24-35 Gy) delivered in 3-5 fractions. In 51.9% of cases, SBRT was delivered to oligoprogressive lesions, to oligorecurrent lesions in 42.3%, while the remaining were patients with synchronous oligometastases and primary disease. Prostate cancer was the most frequent primary histology in 50% of cases, followed by breast (26.9%), uterus (7.7%), NSCLC (5.8%). Median age was 70 years (range 49-88), Males = 30; Females = 22). In the majority of patients (73%) SBRT was delivered to a single oligometastasis, with up to 4 NSBM treated simultaneously, with the thorax the most frequent site of SBRT (53.8%), followed by the pelvis (46.1%). Concurrent systemic therapy was administered in 55.8% of patients. After a median follow-up of 31.8 months (range, 12-33.4), 1- and 2-year LC rates were respectively 98.1% and 96%, while DPFS rates were 57.7% and 31.5%. 1- and 2-year TNST were respectively 82.7% and 42.9% with worse outcomes for patients with oligoprogressive disease at univariate analysis (p = 0.018). Concerning OS, 1- and 2-year rates were, respectively, 94.3% and 90%, with a statistically significant relation with male gender and prostate histology for improved outcomes (p = 0.003 and p = 0.004); also > 1 metastasis treated was reported to correlate with lower OS rates (p = 0.016). No G ≥ 3 adverse events were observed, with 15.4% of cases developing acute G2 pain after SBRT, fully resolved after oral steroids.
CONCLUSIONS: In our experience, SBRT for NSBM was safe and effective with minimal toxicity and excellent results in terms of LC. Prostate histology relates to improved outcomes and better disease control rates.

Keywords:  Bone metastases; Non-spine; Stereotactic body radiotherapy

DOI:  https://doi.org/10.1007/s12094-026-04444-z
Front Immunol. 2026 ;17 1747604

Autoantibodies combined with systemic inflammation markers for predicting bone metastases in non-small cell lung cancer patients.

Song Cheng, Dabin Chen, Rongrong Du, Chao Wang, Jiawen Xian, Liyuan Liu, Hong Wan, Ting Ye.

   Objective: This study aims to develop and validate a nomogram model that integrates autoantibodies and systemic inflammation markers to predict the risk of bone metastases in patients with non-small cell lung cancer (NSCLC). Additionally, we propose a novel approach for risk stratification and adjunctive assessment of bone metastases in NSCLC patients, aiming to support clinical decision-making.
Methods: This retrospective study analyzed 323 NSCLC patients treated at the Affiliated Hospital of Southwest Medical University from January 2020 to July 2024. Comprehensive clinical, laboratory, and imaging data were collected. Key predictors included histology, TNM stage, ANA fluorescence patterns, anti-extractable nuclear antigens (anti-ENAs), SIRI, LWR, and anti-AMA-M2. Least absolute shrinkage and selection operator (LASSO) regression was used for feature selection, and variables with non-zero coefficients were incorporated into a nomogram. The model was validated internally using receiver operator characteristic curve (ROC) analysis, calibration curves, and decision curve analysis (DCA). The incremental value of novel biomarkers was assessed using NRI and IDI.
Results: Seven variables were retained in the final nomogram, including histology, TNM stage, anti-ENAs, SIRI, LWR, anti-AMA-M2, and ANA fluorescence pattern. The nomogram demonstrated good discriminatory ability, with the receiver operating characteristic curve (AUC) of 0.921 (95% CI: 0.887-0.955) in the training cohort and 0.870 (95% CI: 0.795-0.945) in the validation cohort. Calibration plots showed good agreement between predicted and observed outcomes. Decision Curve Analysis (DCA) indicated that the nomogram provided a higher net benefit compared to "treat-all" and "treat-none" strategies across a range of threshold probabilities. The inclusion of novel biomarkers significantly improved the model's predictive performance, as evidenced by continuous NRI (0.822, P< 0.001) and IDI (0.121, P<0.001).
Conclusion: The nomogram developed in this study offers a reliable tool for individualized risk prediction of bone metastasis in NSCLC patients. Incorporating autoantibody and inflammation-related biomarkers significantly enhances the predictive performance, which may help in risk stratification and early intervention.

Keywords:  anti-ENAs; autoantibodies; bone metastases; nomogram; non-small cell lung cancer (NSCLC); systemic inflammation markers

DOI:  https://doi.org/10.3389/fimmu.2026.1747604
Support Care Cancer. 2026 Jun 08. pii: 625. [Epub ahead of print]34(7):

Mepilex Lite dressing in the management of radiation dermatitis-a systematic review and meta-analysis of randomized controlled trials.

Henry C Y Wong, Britney Zhang, Shely Kagan, Christina Yang, Shirley S W Tse, Laura Tang, Caroline Hircock, Shing Fung Lee, Tarek Hijal, Amir H Safavi, Irene Karam, Edward Chow.

   INTRODUCTION: Radiation dermatitis is a common side effect of radiation therapy, often affecting patient comfort and may lead to treatment interruption. This systematic review and meta-analysis aimed to evaluate the effectiveness of Mepilex Lite dressings compared to standard care in managing radiation dermatitis.
METHODS: Following PRISMA guidelines, a comprehensive search of Cochrane CENTRAL, CINAHL, Embase, and MEDLINE was conducted up to July 2025. Randomized controlled trials (RCTs) comparing Mepilex Lite to standard of care in patients undergoing radiation therapy were included. Primary outcomes included changes in dermatitis severity using validated grading systems. Secondary outcomes were time to wound healing, patient-reported symptoms, and quality of life. Meta-analyses were conducted using Revman, and risk of bias was assessed using the Cochrane Risk of Bias 2 tool.
RESULTS: Three RCTs involving 186 patients were included. Two studies focused on breast cancer and one on nasopharyngeal cancer. Mepilex Lite was applied at the onset of radiation-induced erythema in two studies and after the development of moist desquamation in one study. Meta-analysis of RISRAS scores from two studies showed significant improvement with Mepilex Lite: combined score mean difference -0.98 (95% CI, -1.41 to -0.56, p < 0.01; I2 = 96%) and researcher-assessed score -0.57 (95% CI, -1.03 to -0.11, p = 0.02; I2 = 93%). Time to wound healing was reported using different measures across studies, preventing meta-analysis. Zhong et al. reported faster healing with Mepilex Lite (median 16 vs. 23 days, p = 0.009), while Paterson et al. observed reduced severity and duration of moist desquamation. Patient-reported outcomes favored Mepilex Lite for symptom relief, including pain and itchiness.
CONCLUSION: Mepilex Lite dressings may help reduce the severity and duration of radiation dermatitis and may improve patient comfort. However, due to significant heterogeneity among studies and variation in outcome reporting, further studies are required to confirm these findings.

Keywords:  Mepilex Lite; Meta-analysis; Radiation dermatitis; Randomized controlled trials

DOI:  https://doi.org/10.1007/s00520-026-10872-y
J Clin Med. 2026 Jun 03. pii: 4328. [Epub ahead of print]15(11):

Long-Term Results of a Comparison Between 15 × 2.633 Gy and 20 × 2.0 Gy for Malignant Spinal Cord Compression in Patients with Longer Expected Survival Times.

Dirk Rades, Christian Staackmann, Darejan Lomidze, Barbara Segedin, Blaz Groselj, Fernando Lopez Campos, Arturo Navarro-Martin, Jon Cacicedo.

  Background/Objectives: A considerable number of patients with malignant spinal cord compression (MSCC) and a longer expected lifespan do not receive upfront surgery but radiation therapy alone. These patients were suggested to benefit from radiation programs with total doses > 30 Gy in terms of better local progression-free survival (LPFS). A previous study compared such regimens, namely 15 × 2.633 Gy over three weeks (34 patients, prospective cohort) and 20 × 2.0 Gy over four weeks (239 patients, control), using a propensity score-adjusted approach. Both regimens were associated with similar rates of overall survival (OS) and LPFS. However, follow-up was limited to 12 months. For long-term survivors, a longer period of follow-up would be desirable. Therefore, the present study was initiated. Methods: Retrospective collection of additional data enabled us to provide OS- and LPFS-rates at 36 months following radiation therapy. Results: In the prospective cohort, 36-month rates of OS and LPFS were 27.0% and 89.7%, respectively. After application of the propensity score-adjusted Cox regression model, 36-month OS-rates (HR 1.454; 95% CI 0.748-2.828; p = 0.270) and LPFS-rates (HR 0.311; 95% CI 0.041-2.352; p = 0.258) appeared not considerably different. Late radiation myelopathy and pathologic vertebral fractures were not identified. Conclusions: The results of the current study suggest that the role of 15 × 2.633 Gy should be further investigated in selected patients with MSCC, particularly when considering its shorter overall treatment time in comparison to 20 × 2.0 Gy. Overall, our findings are hypothesis-generating rather than confirmatory.

Keywords:  higher total doses; long-term results; longer expected survival time; malignant spinal cord compression; radiation therapy alone

DOI:  https://doi.org/10.3390/jcm15114328
JMIR Res Protoc. 2026 Jun 08. 15 e81489

Efficacy and Safety of Electroacupuncture for Postoperative Insomnia in Patients With Spinal Metastasis: Protocol of a Prospective, Multicenter, Randomized Controlled Study.

Cuifang Jiang, Mengchen Yin, Xia Peng, Junqiao Zhao, Fan Zhang, Junming Ma, Dong Wang, Yan Cao.

   Background: Postoperative insomnia is one of the common complaints caused by spinal metastatic cancer surgery. It affects patients' functional recovery, greatly reduces their quality of life, and adversely impacts disease prognosis. Compared with traditional pharmacological treatments, acupuncture is an alternative therapy for postoperative insomnia. However, standardized, high-quality randomized controlled trials on electroacupuncture for postoperative insomnia in patients with spinal metastasis (SM) are scarce, and there is a lack of clear inclusion criteria for this specific population. Postoperative insomnia in patients with SM has distinct clinical characteristics compared with general cancer-related insomnia, necessitating targeted investigation.
Objective: This study aims to evaluate the efficacy and safety of electroacupuncture in the treatment of postoperative insomnia in patients with SM, and to provide high-level clinical evidence for the inclusion of electroacupuncture in the clinical management plan of postoperative insomnia in patients with SM.
Methods: This is a study protocol for a randomized controlled trial. We will randomly assign 196 patients with insomnia after spinal metastatic cancer surgery to the acupuncture group (n=98) or the control group (sham acupuncture group; n=98). All participants will be treated on the first day after surgery and receive 12 sessions in total (30 min per session, 3 sessions per wk for 4 weeks). The primary outcome is the change in Pittsburgh Sleep Quality Index score from baseline to post treatment (wk 4). The secondary outcomes include actigraphy records (sleep efficiency, number of sleep awakenings, total sleep time, sleep latency, and wake after sleep onset), Insomnia Severity Index, Spine Oncology Study Group Outcomes Questionnaire 2.0, and Patient Health Questionnaire-9. All results will adhere to the intention-to-treat principle and will be evaluated at baseline, posttreatment (wk 4), and follow-up (wk 12).
Results: This study was funded in June 2023 (supported by the Project of Shanghai Municipal Health Commission, National Natural Science Foundation of China, etc). Recruitment will start in mid-2026 and end in December 2027. Data collection will be completed in October 2027, and data analysis is expected to be finished in December 2027. The results of this study are anticipated to be published in the first half of 2028.
Conclusions: This study is designed to rigorously assess the therapeutic value of electroacupuncture for postoperative insomnia in patients with SM. If proven effective, electroacupuncture is expected to become a safe and feasible alternative or complementary therapy for this population, reducing reliance on hypnotic drugs and improving patients' quality of life and prognosis. The results will fill the gap in current clinical evidence for electroacupuncture in the treatment of spinal metastatic postoperative insomnia and provide a basis for the optimization of clinical treatment strategies.

Keywords:  clinical protocol; electroacupuncture; postoperative insomnia; randomized controlled trial; sleep quality; spinal metastasis

DOI:  https://doi.org/10.2196/81489