bims-rebome Biomed News
on Management of bone metastases
Issue of 2026–06–21
six papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata
  1. Network meta-analysis of bisphosphonates in the treatment of bone metastases from breast cancer.
  2. Human Versus Machine in Survival Prediction for Metastatic Spinal Cord Compression: A Retrospective Cohort Study.
  3. The role of surgical timing in survival of patients with spinal metastases.
  4. Diagnostic Concordance Between Contrast-Enhanced CT and Bone Scintigraphy for Detecting Bone Metastases in Clinical T3/N1 Breast Cancer.
  5. PI-RADS v2 score may be as a predictor of bone metastasis in prostate cancer.
  6. Does 18F-sodium fluoride PET/CT have a role in the assessment of response to 223Ra therapy in men with prostatic bone metastases?
  1. Int J Clin Pharmacol Ther. 2026 Jun 15.
    Network meta-analysis of bisphosphonates in the treatment of bone metastases from breast cancer.
    Li-Wen Zhang, An Huang, Hong-Fang Ma, Jun Shen.
       OBJECTIVE: Through a network meta-analysis, this study aimed to systematically evaluate the efficacy and safety of bisphosphonates in reducing skeletal-related events in patients with bone metastases from breast cancer, providing clinical guidance for treatment selection.
    MATERIALS AND METHODS: Randomized controlled trials (RCTs) on bisphosphonate therapy for bone metastases in breast cancer were retrieved from PubMed, Cochrane, and Embase databases from inception to January 2025. Statistical analyses were performed using Stata software.
    RESULTS: 22 studies involving 14,934 patients were included. The bisphosphonates evaluated were pamidronate, zoledronate, clodronate, and ibandronate. Regarding the reduction of pathological fractures, the efficacy ranking was clodronate > ibandronate > pamidronate > zoledronate. Significant differences were found between clodronate and pamidronate (OR = -1.41, 95% CI: -2.78 to -0.04) and between clodronate and zoledronate (OR = -1.44, 95% CI: -2.85 to -0.04). For hypercalcemia reduction, zoledronate was more effective than clodronate and pamidronate, though differences were not statistically significant (p > 0.05). In terms of safety, ibandronate showed fewer adverse reactions than clodronate and zoledronate, with a significant difference between ibandronate and zoledronate (OR = -1.14, 95% CI: -1.99 to -0.28).
    CONCLUSION: Clodronate was most effective in reducing pathological fractures, zoledronate was superior in controlling hypercalcemia, and ibandronate demonstrated the best safety profile. Further clinical studies are warranted to clarify the comparative advantages of each bisphosphonate and support individualized treatment decisions.
    DOI:  https://doi.org/10.5414/CP204946
  2. Cureus. 2026 May;18(5): e108858
    Human Versus Machine in Survival Prediction for Metastatic Spinal Cord Compression: A Retrospective Cohort Study.
    Vaishnavi Sharma, Rawan Masarwa, Jonathan Dimitry, Khalid Salem, Nasir A Quraishi, Elie Najjar.
       BACKGROUND: Accurate survival prediction in metastatic spinal cord compression (MSCC) is critical for guiding treatment decisions, yet remains challenging, particularly for intermediate survival durations. We compared the accuracy of oncologist judgment, surgeon-calculated Tokuhashi scores, and ChatGPT-assisted predictions in estimating survival outcomes in MSCC patients.
    METHODS: This retrospective study included 100 patients (n = 100) referred to the Centre for Spinal Studies and Surgery, Queen's Medical Centre, a tertiary spinal oncology center in Nottingham, United Kingdom, with radiologically confirmed MSCC. Anonymized clinical data were used to calculate surgeon Tokuhashi scores, document oncologist-estimated life expectancy, and generate ChatGPT-assisted survival predictions based on both literature review and Tokuhashi calculation. Predictions were compared against actual survival outcomes (<6 months, six to 12 months, >12 months). Machine learning analyses identified key predictors of survival.
    RESULTS: Overall prediction accuracy was 53% for ChatGPT Tokuhashi-based predictions, 49% for surgeon Tokuhashi scores, 47% for oncologist judgment, and 36% for ChatGPT literature-based estimates. Recall for short survival (<6 months) was the highest with the surgeon (70%) and ChatGPT Tokuhashi (68%) methods, whereas intermediate survival (six to 12 months) remained difficult to predict across all modalities. For long-term survival (>12 months), oncologists performed better (74% recall). Functional status (Karnofsky score) and patient age emerged as the strongest survival predictors across logistic regression, random forest, decision tree, and XGBoost models, surpassing primary tumor type and metastasis burden.
    CONCLUSIONS: Structured prognostic tools and AI-assisted scoring can complement clinical judgment in predicting short-term survival in MSCC. However, intermediate-term survival prediction remains a critical unmet need. Future prognostic strategies should prioritize dynamic functional metrics over static tumor classifications to improve personalized decision-making.
    Keywords:  ai and machine learning; metastatic spinal cord compression; prognostic modelling; survival analysis; treatment decision-making
    DOI:  https://doi.org/10.7759/cureus.108858
  3. Int J Clin Oncol. 2026 Jun 16.
    The role of surgical timing in survival of patients with spinal metastases.
    Miklós Kopa, Ádám Kővári, Lukács Németh, János Báskay, Péter Pollner, Zoltán Nagy, Péter Banczerowski, Tamás Mezei.
       BACKGROUND: Spinal metastases commonly cause pain, neurological deterioration, and instability. Surgery is palliative, aiming to relieve symptoms and maintain oncologic treatment eligibility. Optimal surgical timing, however, remains debated.
    METHODS: We retrospectively analyzed 664 patients who underwent 760 operations for spinal metastases at Semmelweis University (2008-2022). Clinical data included demographics, comorbidities, primary tumor, neurological status, surgical approach, and timing of surgery relative to the symptom onset. Survival was assessed with both Kaplan-Meier and log-rank testing, with subgroup analyses by surgical timing and operative hours.
    RESULTS: Pain (83%) and motor deficits (46%) were the most frequent symptoms. Lung, renal, breast, and hematologic cancers predominated. Median survival was 294 days; 30% exceeded two years. No survival advantage was detected for conventional acute surgical thresholds (≤ 48 h, ≤ 72 h, ≤ 1 week). Delays beyond one week correlated with reduced survival. Pain improved postoperatively in ~ 90% of cases, independent of timing. Severe preoperative motor dysfunction predicted poor survival and recovery, emphasizing the need for urgent surgery in this subgroup. Procedures during working hours were associated with superior postoperative symptom control (OR 3.3, p = 0.003), though survival outcomes were unchanged.
    CONCLUSIONS: Surgical management of spinal metastases provides consistent pain relief. Urgent intervention is critical in patients with progressive motor deficits, whereas multidisciplinary preoperative optimization is preferable in others. Operations during working hours yield better symptomatic outcomes, but survival remains primarily determined by the oncologic disease burden. Prospective multicenter studies are warranted to refine timing guidelines.
    Keywords:  Operation timing; Prognosis; Spinal metastases; Surgical treatment; Survival
    DOI:  https://doi.org/10.1007/s10147-026-03099-8
  4. Cureus. 2026 May;18(5): e108758
    Diagnostic Concordance Between Contrast-Enhanced CT and Bone Scintigraphy for Detecting Bone Metastases in Clinical T3/N1 Breast Cancer.
    Haroon Khan, Maryam Hidayat, Hajira Arif, Bushra Rehman.
       BACKGROUND: Bone metastasis is a critical determinant of staging, prognosis, and treatment planning in patients with breast cancer. In patients with higher-risk localized disease (clinical T3 and/or N1), both contrast-enhanced computed tomography (CT) and bone scintigraphy are frequently used; however, the benefit of regular bone scintigraphy in an already-performed CT scan is debatable.
    OBJECTIVE: To evaluate the concordance between contrast-enhanced CT (CECT) and whole-body bone scintigraphy for detecting bone metastases during initial staging in patients with clinically T3 and/or N1 breast cancer, and to assess the incremental diagnostic value of bone scintigraphy in selected patients.
    METHODS: This retrospective observational study was carried out during a ten-year period (June 1, 2015, to May 31, 2025) at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar, Pakistan (SKMCH&RC). Women with newly diagnosed histopathologically confirmed clinical T3 and/or N1 breast cancer who underwent CECT (chest/abdomen/pelvis) and whole-body bone scintigraphy for initial staging were consecutively included. Patients who had prior treatment or recurrent disease, incomplete imaging documentation, metastases distant from the bone, or primary bone disease were excluded. The imaging results of the bone metastases were classified as positive or negative, and the concordance between the different modalities was evaluated by Cohen's kappa statistics and diagnostic accuracy measures.
    CONCLUSION: CECT demonstrated high overall concordance with whole-body bone scintigraphy for detecting bone metastases during initial staging of clinically T3/N1 breast cancer. However, bone scintigraphy identified a limited number of additional CT-negative cases, suggesting a modest incremental diagnostic value in selected patients.
    Keywords:  bone metastasis; bone scintigraphy; breast cancer biology; contrast-enhanced ct; staging
    DOI:  https://doi.org/10.7759/cureus.108758
  5. Indian J Cancer. 2026 Jan 01. 63(1): 82-89
    PI-RADS v2 score may be as a predictor of bone metastasis in prostate cancer.
    Ting Liu, Cheng H Zhu, Kang Yang, Yang Du, Fan Cheng.
       BACKGROUND: To explore the independent influencing factors of PCa bone metastasis and evaluate the role of prostate imaging.
    METHODS: The clinic data such as age, prostate volume, tPSA and fPSA . Univariate and multivariate analyses were performed to investigate the independent influencing point of the risk factors. Nomogram and ROC curve were generated to establish the prediction model. The calibration curve, leave-one-out cross validation and independent external validation were performed to evaluate the prediction model.
    RESULTS: This study enrolled 325 newly diagnosed PCa patients at two hospitals. Univariate and multivariate analyses showed only tPSA , cTx, ALP, and PI-RADS v2 score were the independent influencing factors of PCa bone metastasis. The cut-off points of PI-RADS v2 score to distinguish bone metastasis was 5. The nomogram was established with a sensitivity of 81.3% and a specificity of 74.5% to predict the probability of PCa bone metastasis. The calibration curve and ROC curve displayed a good value of the prediction model. Leave-one-outcross validation showed the prediction model could classify 79.8% cases accurately. External data validation displayed sensitivity of 78.4% and a specificity of 79.1%.
    CONCLUSIONS: PI-RADS v2 score could predict PCa bone metastasis, the prediction model may help discovered PCa bone metastasis.
    Keywords:  Bone metastasis; PI-RADS v2; prediction model; prostate cancer
    DOI:  https://doi.org/10.4103/ijc.ijc_1015_22
  6. Eur J Nucl Med Mol Imaging. 2026 Jun 20.
    Does 18F-sodium fluoride PET/CT have a role in the assessment of response to 223Ra therapy in men with prostatic bone metastases?
    Glen M Blake, Ricardo Donners, Amelia E B Moore, Holly Tovey, Aude Espinasse, Matthew D Blackledge, Sue Chua, Yong Du, Emma Hall, Dow-Mu Koh, Emilia Nuzzaci, Nina Tunariu, Christopher C Parker, Gary J R Cook.
       BACKGROUND: The REASURE study investigated imaging biomarkers in men receiving 223Ra treatment for prostate cancer bone metastases. We used REASURE data to compare and contrast the roles of [18F]NaF PET/CT measurements of maximum standardised uptake value (SUVmax) and bone metabolic flux (Ki) as markers of response.
    METHODS: Thirty-four men with prostatic bone metastases received up to six cycles of 223Ra (55 or 88 kBq/kg) at four-weekly intervals. Whole-body diffusion-weighted MRI and [18F]NaF PET/CT images were acquired at baseline and 4, 12, and 24 weeks later. Values of the apparent diffusion coefficient (ADC, a measure of tumour response), SUVmax, and a novel surrogate measurement of Ki using a PET/CT SUV measurement in the left ventricle were monitored in up to 5 bone metastases in each participant. Multilinear regression analysis (MLR) was performed to determine if changes in ADC were predicted by changes in SUVmax or Ki. Radium dose and baseline SUVmax were additional independent variables.
    RESULTS: ADC values increased throughout the study, while SUVmax and Ki decreased. MLR analysis showed that baseline SUVmax and 223Ra dose predicted ADC response (P < 0.001 and P < 0.01, respectively). Changes in SUVmax and Ki at 4, 12, and 24 weeks failed to predict the changes in ADC, showing decoupling between MRI and PET/CT measurements as markers of response. Changes in Ki were a highly significant predictor of changes in SUVmax (P < 0.001), reflecting the strong correlation between these two measurements.
    CONCLUSIONS: Baseline SUVmax was the best predictor of ADC response, followed by 223Ra dose. Changes in SUVmax and Ki failed to predict changes in ADC, suggesting that the changes in the PET/CT variables reflected the effect of 223Ra uptake on osteoblasts rather than a tumoricidal effect. A decrease in SUVmax seen on post-therapy [18F]NaF PET/CT scans should not be interpreted as evidence of tumour regression.
    TRIAL REGISTRATION: ISRCTN ISRCTN17805587. Registered 21/01/15.
    Keywords:   18F]NaF PET/CT imaging; Bone metabolic flux (Ki); Bone metastases; Diffusion-weighted MRI; Maximum standardised uptake values; Prostate cancer; Radium-223 therapy
    DOI:  https://doi.org/10.1007/s00259-026-08009-8
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