bims-rebome 2026-07-05 papers

bims-rebome

Biomed News

on Management of bone metastases

Issue of 2026–07–05
eleven papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata

Postoperative survival in patients undergoing surgery for long bone metastases: a systematic review and Meta-analysis of outcomes across primary tumor types.
[Surgical management of spinal metastases].
A novel inflammatory-nutritional nomogram for predicting survival after minimally invasive surgery for spinal metastases: a comparison with the Katagiri and SORG systems.
Colorectal Cancer Progression and Bone Metastasis: Molecular Mechanisms, Tumor Microenvironment, and Tumor-Bone Crosstalk.
Complications, reoperations, and revisions after surgical treatment of humeral metastases with modular prosthesis, intramedullary nailing or plate fixation: a retrospective analysis.
Instrumentation failure after lumbar spondylectomy for spinal tumors: a systematic review and pooled individual patient analysis.
Cytokine Networks Reprogramming the Osteo-Immune Microenvironment in Cancer Bone Metastasis.
BoneCoT: multicentre validation of a whole-body skeleton foundation model for bone metastases guided by clinician-derived chain of thought.
Trends in radiotherapy fractionation for bone metastases: a multi-center study of practice patterns before, during, and after COVID-19.
Retrospective Assessment of Adjacent Fracture Risks in Vertebroplasty, Kyphoplasty, and Bone-Tumor Radiofrequency Ablation.
Launching an Image-Guided Percutaneous Osteosynthesis Program: A PRISM-RE-AIM Implementation Framework.

J Bone Oncol. 2026 Aug;59 100775

Postoperative survival in patients undergoing surgery for long bone metastases: a systematic review and Meta-analysis of outcomes across primary tumor types.

Tom M de Groot, Jeroen D R Koning, Michelle R Shimizu, Date van der Meij, Olivier Q Groot, Joris J W Ploegmakers, Job N Doornberg, Paul C Jutte.

   Background: Surgery for long bone metastases is performed to alleviate pain, restore function, and improve quality of life. Accurate postoperative survival estimates are essential for surgical planning and shared decision-making, yet no comprehensive synthesis exists across primary tumor types. This systematic review aimed to characterize postoperative survival and its temporal trend in patients undergoing surgery for long bone metastases.
Methods: A systematic literature search was performed in PubMed, EMBASE, and Cochrane Library. Studies reporting survival following surgery for long bone metastases were eligible. Pooled survival estimates were computed using restricted maximum likelihood random-effects meta-analysis. Secular trend analysis used weighted linear regression with study sample size as weights. Risk of bias was assessed at the study level using the Joanna Briggs Institute (JBI) critical appraisal tools, with separate checklists applied for cohort studies and case series.
Results: A total of 155 studies comprising 27,133 patients were included (1973-2024). Pooled 1-year survival was 47.9% (95% CI 44.1-51.7%, 95% prediction interval 17.7-79.7%, I2 = 89%; n = 101 studies), declining to 30.8% at 2 years and 16.9% at 5 years. Median survival was 8.0 months (IQR 6.0-11.0 months). Considerable variation was observed by tumor type: thyroid carcinoma and myeloma demonstrated the highest 1-year survival (90.0% and 70.6%, respectively), followed by breast cancer (56.4%), while lung cancer (22.7%), hepatocellular carcinoma (23.2%), and prostate cancer (26.5%) had the lowest. In the contemporary cohort (recruitment end ≥2016; n = 62 studies), pooled 1-year survival was 52.2% (95% CI 47.9-56.4%) and median survival was 10.0 months (IQR 7.0-13.6 months). A statistically significant positive secular trend was identified (+0.47% per year; 95% CI +0.11 to +0.82%; p = 0.012).
Conclusions: Postoperative survival varies considerably by primary tumor type and has improved significantly over the past decade. These findings, although non-definitive and descriptive, provide contemporary long-bone metastatic disease specific survival benchmarks to inform prognostic counselling.

Keywords:  Bone metastases; Long bone; Prognosis; Surgery; Survival; Systematic review; meta-analysis

DOI:  https://doi.org/10.1016/j.jbo.2026.100775
Orthopadie (Heidelb). 2026 Jul 01.

[Surgical management of spinal metastases].

Lars Wessels, Julia Onken, Peter Vajkoczy.

   BACKGROUND: Spinal metastases from malignant tumors represent an increasingly relevant clinical problem due to improved systemic therapies, prolonged survival, and the growing prevalence of long-term survivors with metastatic disease. The spine is not only a central biomechanical component of the musculoskeletal system, but also protects the spinal cord and spinal nerves. Accordingly, the treatment of spinal metastases is complex and must always be embedded within an overarching oncological treatment concept.
BASICS: This review summarizes epidemiological and pathophysiological principles and presents contemporary indications and operative strategies for spinal metastases. The central goals of surgery are histological diagnosis, decompression of neural structures, restoration or preservation of mechanical stability, pain relief, and maintenance of neurological function and quality of life. Surgical decision-making should be interdisciplinary and should consider not only imaging findings and neurological status, but also tumor biology, radiosensitivity, systemic treatment options, prognosis, patient preference, and rehabilitation potential.
THERAPY: Modern surgical treatment of spinal metastases has undergone a paradigm shift: maximal tumor resection is no longer routinely the primary objective; instead, the focus has shifted toward function-preserving, low-morbidity interventions embedded within a multimodal treatment strategy. Concepts such as NOMS, SINS, and the Bilsky grading system support structured decision-making.
AIMS: Minimally invasive procedures, percutaneous instrumentation, navigation, intraoperative three-dimensional imaging, modern implant materials, and increasingly AI-based prognostic models allow a patient-specific calibration of surgical invasiveness. The overall aim is to preserve neurological function and quality of life, control local tumor progression, and minimize treatment-delaying morbidity.

Keywords:  Minimally invasive surgery; Quality of life; Radiosurgery; Spinal fusion; Spinal neoplasms

DOI:  https://doi.org/10.1007/s00132-026-04856-3
Eur Spine J. 2026 Jul 01.

A novel inflammatory-nutritional nomogram for predicting survival after minimally invasive surgery for spinal metastases: a comparison with the Katagiri and SORG systems.

Cheng Chen, Ruoou Chen, Dajun Zeng, Gaojian Tao, Ying Huang.

   PURPOSE: Accurate survival prediction is paramount for selecting appropriate candidates for minimally invasive surgery (MIS) among patients with spinal metastases. Traditional scoring systems often neglect the host's systemic inflammatory response. This study aimed to develop a prognostic nomogram integrating the Glasgow Prognostic Score (GPS) and Lymphocyte-to-Monocyte Ratio (LMR) and evaluate its efficacy against the established Katagiri and SORG systems.
METHODS AND MATERIALS: A retrospective study was conducted on 172 patients who underwent MIS (percutaneous vertebroplasty and/or radiofrequency ablation) for spinal metastases. Patients were divided into training (n = 120) and testing (n = 52) cohorts. Independent prognostic factors were identified using multivariate Cox regression to construct a nomogram. Model performance was evaluated using Area Under the Curve (AUC), calibration plots, Decision Curve Analysis (DCA), Net Reclassification Improvement (NRI), and Integrated Discrimination Improvement (IDI).
RESULTS: Multivariate analysis identified eight independent prognostic factors: clinical profile, surgical modality, systemic therapy, analgesic use, bone metastasis, visceral metastasis, LMR, and GPS. The new nomogram demonstrated excellent discrimination with 12-month AUCs of 0.886 (training) and 0.831 (testing), significantly outperforming the Katagiri (AUC 0.740) and SORG (AUC 0.710) systems (p < 0.001). Calibration plots revealed high agreement between predicted and observed survival. Furthermore, the new model showed significantly improved predictive accuracy over Katagiri (NRI 0.415; IDI 0.227) and SORG (NRI 0.391; IDI 0.289) at 12 months. A risk score cutoff of 2.09 effectively stratified patients into low- and high-risk groups (p < 0.001).
CONCLUSIONS: By integrating objective inflammatory-nutritional markers with clinical factors, this novel nomogram provides enhanced survival prediction compared to traditional anatomical scoring systems. It serves as a robust tool for guiding personalized palliative decision-making in the era of modern systemic therapy.

Keywords:  Glasgow prognostic score; Lymphocyte-to-monocyte ratio; Minimally invasive surgery; Prognostic nomogram; Spinal metastases; Systemic inflammatory markers

DOI:  https://doi.org/10.1007/s00586-026-10036-w
Cancer Manag Res. 2026 ;18 579585

Colorectal Cancer Progression and Bone Metastasis: Molecular Mechanisms, Tumor Microenvironment, and Tumor-Bone Crosstalk.

Xiang Qi, Shuai Hao, Yue Sun, Manglai Li, Jingyuan Yang, Lei Kang, Liansheng Zhang, Hairui Wang.

  Colorectal cancer (CRC) ranks as the third most common malignancy globally and represents one of the main causes of cancer-related death. This narrative review provides a comprehensive synthesis of recent advances in the molecular mechanisms underlying CRC bone metastasis, with an emphasis on key signaling pathways, tumor microenvironment interactions, and potential therapeutic targets. Bone is a relatively uncommon metastatic site in advanced CRC (1.2-12% of patients), but it frequently coexists with hepatic or pulmonary metastases and triggers skeletal-related events (SREs) such as pathological fractures, spinal cord compression, and hypercalcemia, which severely compromise patients' quality of life and survival. Although the molecular mechanisms of CRC and its bone metastasis have been extensively studied, the exact mechanisms underlying its initiation and progression remain incompletely elucidated. Here, we review recent progress focusing on TGF-β signaling, epithelial-mesenchymal transition (EMT), the tumor microenvironment (TME), the Wnt/β-catenin pathway, chemokine regulation, and immune cell interactions within the bone niche. Unlike previous reviews, this article critically distinguishes CRC-specific evidence from data extrapolated from other cancers and provides an evidence-level table to guide clinical translation. By integrating clinical, translational, and preclinical evidence, we aim to present a theoretical basis for understanding CRC bone metastasis and for developing targeted therapeutic strategies.

Keywords:  TGF-β signaling; Wnt/β-catenin pathway; bone metastasis; colorectal cancer; tumor microenvironment; tumor-bone crosstalk

DOI:  https://doi.org/10.2147/CMAR.S579585
Eur J Orthop Surg Traumatol. 2026 Jun 29. pii: 258. [Epub ahead of print]36(1):

Complications, reoperations, and revisions after surgical treatment of humeral metastases with modular prosthesis, intramedullary nailing or plate fixation: a retrospective analysis.

Konstantina Solou, Filippo Tamburini, Monica Cosentino, Federica Zuccheri, Barbara Dozza, Barbara Bordini, Davide Maria Donati, Costantino Errani.

   PURPOSE: Modular prosthesis, intramedullary nailing and plate fixation are surgical options for humeral metastasis, but the optimal treatment for pathological or impending fractures remains controversial. This study evaluated complications, reoperations, and revisions in patients with humeral metastases treated with these surgical techniques.
METHODS: We retrospectively analyzed 115 patients with humeral metastases treated with modular prosthesis (n = 33), intramedullary nailing (n = 69) or plate fixation (n = 13). We evaluated complications, reoperations without implant removal and revisions requiring implant removal. Cumulative incidence of complications and death was estimated using competing risk analysis.
RESULTS: In modular prosthesis group, 5/33 patients had complications (15.1%): three had subluxations or instability treated conservatively, one had local disease progression treated with embolization and radiotherapy, and one had deep infection who required revision. In intramedullary nailing group, 8/69 patients had complications (11.6%): seven had local disease progression and one had mechanical implant failure. Two patients required reoperation due to local disease progression, and none required revision. In plate fixation group, 4/13 patients had complications (30.7%): two had mechanical implant failure, one had local disease progression, and one had deep infection. Reoperation was required in one patient due to infection, while revision was required in two patients: one patient due to local disease progression and one patient due to mechanical implant failure.
CONCLUSION: Modular prosthesis, intramedullary nailing and plate fixation were associated with distinct complication profiles. Modular prostheses were most commonly associated with instability, intramedullary nails with local disease progression, and plate fixation with a relatively high proportion of complications and revisions. Given the heterogeneity of anatomical location and treatment indications, these findings should be interpreted descriptively rather than as evidence of superiority of one technique over another.

Keywords:  Bone metastasis; Complications; Humeral metastasis; Intramedullary nailing; Modular prosthesis; Plate fixation; Reoperations; Revisions; Surgical treatment

DOI:  https://doi.org/10.1007/s00590-026-04847-2
Eur Spine J. 2026 Jun 30.

Instrumentation failure after lumbar spondylectomy for spinal tumors: a systematic review and pooled individual patient analysis.

Alexander Alexandrov, Ali Haider Bangash, Liza Belman, Victoria Cao, Saikiran Murthy, Yaroslav Gelfand, Oluwaseun O Akinduro, C Rory Goodwin, Sheng-Fu Larry Lo, Daniel M Sciubba, John H Shin, Ziya L Gokaslan, Reza Yassari, Rafael De la Garza Ramos.

   PURPOSE: Instrumentation failure (IF) is a major complication after lumbar spondylectomy for spinal tumors, yet risk factors remain poorly defined. The present study aimed to determine the prevalence of IF and identify variables associated with IF and revision surgery using pooled individual patient data.
METHODS: A systematic review and individual patient data analysis were performed per PRISMA guidelines. PubMed, CDSR, and Epistemonikos were searched through January 2025, and additional patient-level data were obtained from prior series. Studies were included if they reported outcomes after lumbar spondylectomy for primary or metastatic tumors. Demographic, tumor, surgical, and (neo)adjuvant therapy variables were extracted. Statistical analyses included chi-square tests, t-tests, and Firth's penalized logistic regression. Variables with p < 0.1 on univariable analysis and considered clinically relevant were entered into a penalized multivariable model, with a sensitivity analysis incorporating estimated blood loss as a surrogate of operative burden.
RESULTS: A total of 169 patients (mean age 40.7 ± 17.6 years) were included after screening. IF occurred in 14% (23/169) of patients, with 96% of those requiring revision. On univariable regression, risk factors for IF included combined approach (OR 4.72, p = 0.01), staged procedures (OR 5.51, p < 0.001), pelvic fixation (OR 5.17, p < 0.001), multilevel spondylectomy (OR 2.74, p = 0.036), longer operative time (OR 1.17 per hour, p = 0.001), and greater blood loss (OR 1.16 per liter, p = 0.034). On primary multivariable analysis incorporating clinically relevant variables, no variable retained statistical significance, although pelvic fixation demonstrated the strongest trend (OR 2.19, p = 0.12). On sensitivity analysis adjusting for operative burden, pelvic fixation was significantly associated with IF (OR 4.95, p = 0.043). Median time to IF was 27 months.
CONCLUSION: IF after lumbar spondylectomy occurs in roughly one in seven patients and is associated with multiple markers of procedural complexity. Although no single independent predictor was identified in the primary multivariable analysis, pelvic fixation demonstrated the strongest association across models, likely reflecting the increased biomechanical demands of lumbosacral constructs. Careful planning, reinforcement strategies, and long-term follow-up are critical to mitigate failure risk.

Keywords:  Instrumentation failure; Lumbar spine; Spinal tumors; Spondylectomy; Systematic review

DOI:  https://doi.org/10.1007/s00586-026-10133-w
Calcif Tissue Int. 2026 Jul 03. pii: 106. [Epub ahead of print]117(1):

Cytokine Networks Reprogramming the Osteo-Immune Microenvironment in Cancer Bone Metastasis.

Toru Hiraga.

  Bone metastasis is a major clinical challenge and is frequently associated with resistance to immunotherapy and progressive skeletal destruction. Although cytokines are recognized as key regulators of both immune responses and bone remodeling, their integrated roles in the bone metastatic niche remain incompletely understood. Here, we propose a conceptual framework in which cytokine-driven osteo-immune reprogramming shapes the bone microenvironment into a state that supports tumor persistence. Within this framework, cytokines can be categorized into three functional groups-immune-dominant mediators, osteo-immune regulators, and divergent factors-whose context-dependent activities collectively coordinate immune suppression and osteoclastic bone destruction. Rather than acting independently, these cytokines form interconnected networks that establish reinforcing interactions, thereby stabilizing an immunologically cold and therapy-resistant niche. This integrated perspective suggests that immune resistance in bone metastasis does not arise solely from tumor-intrinsic properties, but emerges from dynamic crosstalk in the osteo-immune axis. The spatiotemporal regulation of cytokine signaling likely defines stage-specific vulnerabilities, providing opportunities for therapeutic intervention. Targeting cytokine networks in combination with immune checkpoint inhibitors and bone-modifying agents may represent a rational strategy to disrupt pathogenic osteo-immune circuits. A deeper understanding of the reprogramming of the bone microenvironment by cytokines will be essential for enabling durable immunotherapeutic responses in patients with bone metastatic disease.

Keywords:  Bone metastasis; Cytokines; Immune microenvironment; Immunotherapy; Osteoclasts; Osteoimmunology

DOI:  https://doi.org/10.1007/s00223-026-01568-w
Nat Biomed Eng. 2026 Jul 02.

BoneCoT: multicentre validation of a whole-body skeleton foundation model for bone metastases guided by clinician-derived chain of thought.

Hui Zhao, Ruipeng Zhang, Zhiyu Wang, Yifeng Gu, Shengyuan Xu, Sheng Wang, Yuehua Li.

Given the rising incidence of bone metastases, computed tomography is widely used worldwide as the initial imaging modality for their detection. Accurate diagnosis of bone metastases demands comprehensive evaluation, yet divergent interpretations among specialists can result in diagnostic discrepancies. In clinical practice, precision diagnosis of bone metastases necessitates multidisciplinary collaboration involving radiologists, pathologists and oncologists. Here, to meet the need for an automated tool that can deliver expert-level insights and predictions by jointly considering multidisciplinary information, we propose BoneCoT, a whole-body skeleton foundation model enhanced through a chain-of-thought (CoT) fine-tuning approach. We pretrained the model on 29.3 million computed tomography images from 30,267 patients across 12 skeletal sites and refined it over a graph of 26 clinically relevant tasks spanning diagnosis, complications, tumour type and biomarkers. Evaluated across 26 tasks and multicentre cohorts from 10 hospitals, BoneCoT outperformed state-of-the-art methods by 20% in area under the receiver operating characteristic curve. Critically, BoneCoT achieved a 40% area under the receiver operating characteristic curve improvement in distinguishing primary from metastatic lesions, significantly surpassing experienced radiologists. These findings show how clinician-derived reasoning can move artificial intelligence towards more integrated diagnostic assessment in complex disease.

DOI: https://doi.org/10.1038/s41551-026-01736-1
Radiat Oncol J. 2026 Jun;44(2): 107-116

Trends in radiotherapy fractionation for bone metastases: a multi-center study of practice patterns before, during, and after COVID-19.

Ellis Slotman, Heidi P Fransen, Roxanne Gal, Joanne M van der Velden, Enja J Bantema-Joppe, Janine G H van Nes, Inge Compter, Judi N A van Diessen, Mirjam E Mast, Paulien G Westhoff, Eva Versteijne, Kim Wortel, Eva de Wee, Natasja J H Raijmakers, Yvette M van der Linden.

   PURPOSE: Trials show similar pain outcomes for hypofractionated and multi-fraction regimens in bone metastases, yet clinical adoption of hypofractionation remains limited. The coronavirus disease 2019 (COVID-19) pandemic may have increased hypofractionation to minimize hospital visits and optimize resources. This study evaluated fractionation patterns before, during and after COVID-19 and compared pain outcomes between regimens in routine practice.
MATERIALS AND METHODS: Data on treatment regimens for bone metastases between 2018 and 2022 were collected from 11 of 22 Dutch radiotherapy departments. Trends in utilization of hypofractionated (1-2 times 8 Gy) and multi-fraction (≥5 fractions) regimens were analyzed. For a subset of patients (n = 278), self-reported pain scores were collected at baseline, 4 and 8 weeks, and 3 months. Pain scores and pain response were compared for hypofractionated and multiple-fraction regimens, with complete (pain score 0) or partial (reduction ≥2 points) response classified as responders.
RESULTS: A total of 17,336 patients were included, receiving 31,677 treatment regimens. The majority of the regimens were hypofractionated (n = 25,790, 81%). The use of hypofractionated regimens ranged from 34% to 99% between radiotherapy departments. A statistically significant increase in hypofractionated regimens was observed since the onset of the COVID-19 pandemic in 2020 (p < 0.001). In an exploratory analysis of patients with available pain scores, pain response in the three months post-treatment did not differ significantly between hypofractionated and multi-fraction regimens (56% vs. 63%, p = 0.406).
CONCLUSION: This study demonstrates a high adoption of hypofractionated regimens, with a slight increase since the COVID-19 pandemic, though considerable variation remains between departments. Pain outcomes were comparable between hypofractionated and multi-fraction regimens, suggesting equal palliation and less treatment burden with hypofractionation.

Keywords:  COVID-19; Pain; Palliative care; Radiation dose hypofractionation

DOI:  https://doi.org/10.3857/roj.2026.00038
Pain Pract. 2026 Jul;26(6): e70182

Retrospective Assessment of Adjacent Fracture Risks in Vertebroplasty, Kyphoplasty, and Bone-Tumor Radiofrequency Ablation.

Soun Sheen, Prit Hasan, Xiaowen Sun, Jian Wang, Claudio Tatsui, Kent Nouri, Saba Javed.

   INTRODUCTION: Percutaneous vertebral augmentation is widely used to provide symptom relief for patients with painful vertebral compression fractures (VCFs), but adjacent fractures remain a known complication. This retrospective study evaluated the risk of adjacent vertebral fractures following different percutaneous vertebral augmentation techniques.
METHODS: A total of 985 encounters from 878 patients who underwent vertebroplasty, kyphoplasty, or bone tumor radiofrequency ablation (BT-RFA) with cement augmentation were included. The primary outcome was incidence of postprocedural adjacent fractures. Associations with demographic and clinical factors including age, sex, BMI, pathologic fractures, bone density, imaging guidance, and number of treated levels were assessed. Statistical analyses included a generalized linear mixed model and Cox proportional hazards models clustered by patient.
RESULTS: Adjacent fracture occurred in 17.8% of encounters. BT-RFA was associated with a significantly lower risk of adjacent fractures compared with kyphoplasty (HR: 0.54, 95% CI:0.36-0.81; p = 0.003) and vertebroplasty (HR: 0.40, 95% CI: 0.27-0.60; p < 0.0001). Multilevel vertebral augmentations increased fracture risk by 1.42-fold, while pathologic fractures lowered the odds of adjacent fracture. No significant associations were found for age, BMI, sex, cement extravasation, or bone density.
CONCLUSION: BT-RFA combined with cement augmentation significantly reduced the risk of adjacent fractures compared to kyphoplasty or vertebroplasty.

Keywords:  adjacent fracture; cancer pain; chronic pain; vertebral augmentation; vertebral compression fracture

DOI:  https://doi.org/10.1111/papr.70182
J Vasc Interv Radiol. 2026 Jun 30. pii: S1051-0443(26)00929-2. [Epub ahead of print] 108918

Launching an Image-Guided Percutaneous Osteosynthesis Program: A PRISM-RE-AIM Implementation Framework.

Sylvain Grange, Louis-Martin Boucher, Nicolas Stacoffe, Radin Behrouzi, Rémi Grange, Jean-Pierre Pelage, Natalia Gorelik.

  Image-guided percutaneous osteosynthesis (IGPO) is an emerging minimally invasive technique for stabilizing metastatic, insufficiency-related, and selected traumatic skeletal lesions. Although technical feasibility and clinical outcomes are increasingly reported, guidance on launching and sustaining IGPO programs remains limited. This expert narrative review proposes an implementation framework based on the Practical, Robust Implementation and Sustainability Model (PRISM) and Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM). Key IGPO, musculoskeletal interventional radiology, and implementation-science publications were identified from PubMed and authors' reference libraries. Selected French and Canadian institutional experiences were synthesized through framework-guided author discussions. This approach was not a systematic review or formal qualitative study. The framework emphasizes institutional readiness, stakeholder engagement, patient selection, imaging and anesthesia access, staffing, radiation safety, adverse-event monitoring, follow-up, and progressive scale-up. Suggested metrics include technical success, procedure duration, radiation exposure, adverse-event grade, pain, mobility, length of stay, reintervention, and patient-reported outcomes.

Keywords:  Bone metastases; Image-guided percutaneous osteosynthesis; Implementation science; International experience; Interventional radiology; Minimally invasive procedure; Multidisciplinary collaboration; Pathological and traumatic fractures

DOI:  https://doi.org/10.1016/j.jvir.2026.108918