bims-rebome 2026-08-02 papers

bims-rebome

Biomed News

on Management of bone metastases

Issue of 2026–08–02
sixteen papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata

Does Duration of Symptoms in Metastatic Spine Disease Affect Recovery and Outcomes? A Systematic Review and Meta-Analysis.
Development and feasibility of the AO spinal metastasis staging (SMS) referral tool: An international multidisciplinary expert panel and survey study.
Diagnostic accuracy of the Mirels score at the humerus in metastatic bone disease: a narrative review.
The impact of lesion size on outcomes following stereotactic body radiotherapy for spinal metastases.
Applicability of RECIST1.1, MDACC and SPINO Tumor Response Criteria After Adjuvant Stereotactic Spinal Radiosurgery in Surgically Treated Spinal Metastases.
Clinical application of urinary NTx in patients with bone metastases from lung cancer.
Spinal metastases in geriatric patients: a retrospective single-center comparison of mortality and surgical outcomes following neurosurgical treatment.
[Evolution of Surgical Outcomes in Spinal Metastases from Solid Tumors: A Comparative Analysis over 2 Decades].
Challenges of Bone Scintigraphy in Assessment of Osseous Metastases in Prostate Cancer: Why it is Time to Reconsider Role of 1⁸F-NaF PET/CT.
[Expert consensus on surgical management of pelvic metastatic tumors (2026 edition)].
Temporal Trajectories of Emotional Well-Being and Quality of Life in Patients Presenting With Metastatic Spinal Cord Compression: A Prospective Observational Study.
Current Treatment Options and Emerging Technologies for Pelvic Bone Tumors: From Limb Salvage to Precision Oncology.
Evolution of Surgical Outcomes in Spinal Metastases from Solid Tumors: A Comparative Analysis over 2 Decades.
Postoperative MRI Artifact Burden After Carbon Fiber-Reinforced PEEK Versus Titanium Instrumentation in Metastatic Spinal Disease.
Proteoglycans as Molecular Regulators of Bone Metastasis: Extracellular Matrix Remodeling, Tumor-Bone Crosstalk, Dormancy, and Therapeutic Opportunities.
Comparison of survival, neurological, and radiographic outcomes between corpectomy and instrumented separation surgery for spinal metastatic disease: A single institutional experience.

Global Spine J. 2026 Jul 30. 21925682261474420

Does Duration of Symptoms in Metastatic Spine Disease Affect Recovery and Outcomes? A Systematic Review and Meta-Analysis.

Harsh Jain, Nick De Oliveira, Advith Sarikonda, Ori Barzilai, Nicolas Dea, Alessandro Gasbarrini, C Rory Goodwin, Cordula Netzer, Jeremy Reynolds, Laurence D Rhines, Arjun Sahgal, Jorrit-Jan Verlaan, Daniel M Sciubba, Ilya Laufer, Scott L Zuckerman.

  Study DesignSystematic review and meta-analysis.ObjectivesWe sought to evaluate the association between pre-treatment symptom duration and outcomes in patients undergoing radiotherapy (RT)/surgery for metastatic epidural spinal cord compression (MESCC).MethodsA systematic review included publications evaluating the association between pre-treatment symptom duration and outcomes after RT/surgery in adults with MESCC. Primary exposure was pre-treatment symptom duration. Outcomes were motor-recovery, ambulation, survival and local control. Pooled-effect-estimates were calculated.Results Of 4639 studies, 37 met the inclusion criteria (26-RT,11-surgery). RT: All studies defined symptom duration as time from motor-weakness onset to RT. Longer symptom duration was associated with improved motor-recovery (Pooled-effect-estimate=2.08, 95%CI:1.68-2.58,p<0.001) and decreased mortality-risk (improved-survival)((Pooled-effect-estimate=0.72, 95%CI:0.69-0.76,p<0.001). Although longer symptom duration was consistently associated with better ambulation and lower local recurrence, few studies precluded meta-analysis. Surgery: Symptom duration was defined as time from neurological-deficit onset to surgery in 7/11 studies; three-studies used ambulatory status, and one-study used both. Longer symptom duration was associated with increased risk-of-death (worse-survival)(Pooled-effect-estimate=1.28, 95%CI:0.54-3.03,p=0.575), though statistically insignificantly. Meta-analysis for motor-recovery wasn't feasible, but most studies found longer symptom duration worsened motor-recovery, while ambulation findings were inconsistent.ConclusionSymptom duration was associated with differing outcome patterns by treatment modality. In RT cohorts, longer symptom duration was associated with improved survival and motor recovery. In surgical cohorts, it trended toward worse survival, though this did not reach statistical significance. Most surgical studies suggested an inverse association between symptom duration and motor recovery. These findings are exploratory, and should be interpreted in context of treatment selection-bias and between-cohort heterogeneity.

Keywords:  motor deficits; radiotherapy; spine tumor; survival; symptom duration

DOI:  https://doi.org/10.1177/21925682261474420
Eur J Cancer. 2026 Jul 24. pii: S0959-8049(26)00734-3. [Epub ahead of print]245 116953

Development and feasibility of the AO spinal metastasis staging (SMS) referral tool: An international multidisciplinary expert panel and survey study.

AO Spine Knowledge Forum Tumor

   PURPOSE: Spinal metastases may progress to debilitating pain, spinal instability, and neurological deficits. Timely referral is essential, yet delays are common because patients often first present to non-spine clinicians where red flags rarely expedite referral and guidelines primarily target spine specialists. We aimed to develop a staging-based referral tool to support non-spine clinicians in recognizing progression and guiding referral urgency.
METHODS: We defined the Spinal Metastasis Staging (SMS) system as four stages: SMS I, asymptomatic; SMS II, inflammatory pain; SMS III, mechanical pain and/or spinal instability; and SMS IV, neurological deficits and/or high-grade spinal cord compression. Stages were translated into a referral algorithm organized by urgency and presented as a pocket map. The tool was refined through regional and international multidisciplinary expert panels, and feasibility was evaluated in an international survey.
RESULTS: Panels endorsed the four-stage SMS system and referral algorithm. Among all survey respondents (n = 120), high acceptability was reported. Among non-spine clinicians (n = 32), 94% found the tool easy to understand, 91% considered the format suitable for clinical use, and 91% anticipated improved referrals. Overall, 88% would use the tool at least occasionally, including 55% who would use it frequently or always.
CONCLUSION: The SMS staging system and referral tool (link) was rated feasible by expert panels and survey respondents. However, only 32 of 120 survey respondents (27%) were non-spine clinicians, so findings in this group are preliminary and may overstate acceptance. The tool should be considered provisional: prospective studies are needed to validate effects on referral and patient outcomes.

Keywords:  Expert consensus; International survey; Oncological emergencies; Referral; Spinal metastases; Staging

DOI:  https://doi.org/10.1016/j.ejca.2026.116953
Int Orthop. 2026 Jul 29.

Diagnostic accuracy of the Mirels score at the humerus in metastatic bone disease: a narrative review.

Romain Leonard, Alexandre Rochwerger, Jean-Camille Mattei.

   PURPOSE: To critically evaluate the diagnostic performance of the Mirels score for pathological fracture risk prediction at the humerus, and to determine whether site-specific factors warrant a revised approach to fracture risk stratification at this location.
METHODS: Narrative review. PubMed was searched without date restriction for studies addressing Mirels score validation at the humerus, alternative fracture risk assessment tools, and clinical outcomes of completed versus impending pathological humeral fracture. Additional studies were identified by manual reference screening.
RESULTS: Three dedicated humeral validation studies report sensitivity of approximately 14% at the standard Mirels threshold of nine or more, equivalent to chance (area under the curve [AUC] 0.51-0.55). A larger cohort supports a revised threshold of eight or more with improved performance (AUC 0.82), identifying cortical breach as the dominant independent predictor of fracture (odds ratio 21.0). Humeral lesions receive lower Mirels scores and less frequent staging computed tomography than femoral lesions despite a higher fracture rate. Completed pathological humeral fracture is associated with increased one-year mortality (hazard ratio 1.28), higher reoperation risk (odds ratio 2.50), and a clinically significant rate of iatrogenic radial nerve palsy (up to 13.9%). Alternative quantitative tools, including computed tomography-based rigidity analysis and finite element analysis, have not been validated at the humerus.
CONCLUSION: The Mirels score performs poorly at its standard threshold when applied to humeral lesions. A revised threshold incorporating cortical breach assessment, combined with systematic staging imaging of the humerus, may reduce avoidable morbidity. Prospective validation of a humerus-specific risk stratification tool is needed.

Keywords:  Bone metastasis; Humerus; Mirels score; Pathological fracture; Prophylactic fixation; Radial nerve palsy

DOI:  https://doi.org/10.1007/s00264-026-06960-7
J Neurosurg Spine. 2026 Jul 31. 1-10

The impact of lesion size on outcomes following stereotactic body radiotherapy for spinal metastases.

Daniel T Lilly, Herika Negri Brito, Wei Wei, Anthony Magnelli, Samuel T Chao, John H Suh, Ehsan H Balagamwala, Lilyana Angelov.

   OBJECTIVE: Stereotactic body radiotherapy (SBRT) for metastatic spinal disease provides effective local control (LC). However, there are limited data evaluating how the pretreatment volume or number of affected vertebral levels impacts treatment effect. Therefore, this study compared the efficacy of spine SBRT treatment on LC, distant progression (DP), and overall survival (OS) between patients with limited spinal disease (≤ 2 vertebral segments or < 50 cm3 pretreatment volume) to those with more widespread spine metastases.
METHODS: All patients with metastatic spinal disease treated with SBRT over a 7-year interval at a single institution were retrospectively reviewed. Baseline demographic characteristics, primary tumor histology, anatomical distribution of metastases, and radiation dosing parameters and toxicity were recorded. LC (absence of recurrent disease at an SBRT-treated segment), DP (progressive disease in a new/untreated segment), and OS were measured. Cox proportional hazards models were used to identify patient and lesion characteristics associated with LC, DP, and OS.
RESULTS: In total, 375 patients were treated with spine SBRT (465 isocenters). Median minimum and maximum target doses were 9.98 and 17.73 Gy, respectively. Overall, 10.1% of patients developed distant DP, while 11.2% of lesions recurred. New or worsening compression fracture occurred in 5.6% of lesions following SBRT, with 1.9% of radiated lesions requiring surgical management of a postradiation compression fracture. Neither radioresistant pathologies nor dose above or below 14 Gy were associated with differences in LC, DP, or OS. Multivariate regression revealed that OS was significantly worse with baseline Karnofsky Performance Status < 80 (HR 1.33, p = 0.030), lesion volume ≥ 50 cm3 (HR 1.37, p = 0.011), or treatment at ≥ 3 vertebral levels (HR 1.42, p = 0.013). DP was significantly worse with lesion volume ≥ 50 cm3 (HR 2.14, p = 0.0229) but was unaffected by number of vertebral segments treated. Notably, however, LC was not significantly associated with high lesion volume or the number of vertebral segments affected.
CONCLUSIONS: Lesion size did not impact the recurrence rates following SBRT for spine metastases in this series, with similar excellent local disease control (> 88%) for patients with ≥ 3 vertebral segments involved or ≥ 50 cm3 pretreatment tumor volume compared to patients with less disease burden. Shorter time to DP and worse OS were both associated with high index lesion volume.

Keywords:  SBRT; SRS; spinal radiation oncology; spine metastases; spine stereotactic radiosurgery; stereotactic body radiotherapy; tumor

DOI:  https://doi.org/10.3171/2026.2.SPINE251402
Medicina (Kaunas). 2026 Jun 29. pii: 1253. [Epub ahead of print]62(7):

Applicability of RECIST1.1, MDACC and SPINO Tumor Response Criteria After Adjuvant Stereotactic Spinal Radiosurgery in Surgically Treated Spinal Metastases.

Francisco Alfredo Call-Orellana, Juan Pablo Zuluaga-Garcia, Romulo Augusto Andrade de Almeida, Alex Beck, Thomas H Beckham, Amol Ghia, Jing Li, Martin C Tom, Mary Frances McAleer, Subha Perni, Chenyang Wang, Debra N Yeboa, Kevin A Cross, Christopher A Alvarez-Breckenridge, Gil Kimchi, Laurence D Rhines, Claudio E Tatsui, Robert Y North.

  Background and Objectives: Up to 40% of patients with cancer develop spinal metastases, and stereotactic spinal radiosurgery (SSRS) achieves high local control rates as definitive or postoperative treatment. Multiple tumor response assessments have been used but their compared clinical performance in post-surgical patients remains unclear. We sought to compare the applicability of RECIST1.1, MDACC and SPINO criteria. Materials and Methods: This IRB-approved retrospective study included patients with high-grade epidural spinal cord compression treated with decompressive surgery followed by adjuvant SSRS, with MRI follow-up available. Lesions were classified according to each of the scale's objective (RECIST1.1 and MDACC) and subjective (SPINO [radiology reports]) criteria. Results: Ninety-four treated levels in 93 patients (median age 58.9 years) were analyzed. Most metastases were thoracic, and all cases had preoperative high-grade epidural spinal cord compression. Adjuvant SSRS was delivered in one or three fractions. Median follow-up was 16 months (range, 1-132), SPINO-based assessment was feasible in 100% of cases, RECIST1.1 in 43.6% and MDACC in 46.8%. Progressive disease criteria were met in 21.3% of cases using SPINO-based assessment, 19.5% using RECIST1.1, and 6.8% using MDACC. Conclusions: The SPINO recommendations provide a practical and comprehensive framework for radiographic response assessment in monitoring spinal metastases treated with a combination of surgical decompression and adjuvant SSRS.

Keywords:  metastasis; spine oncology; stereotactic radiotherapy; tumor response

DOI:  https://doi.org/10.3390/medicina62071253
J Bone Oncol. 2026 Aug;59 100784

Clinical application of urinary NTx in patients with bone metastases from lung cancer.

Lan Jiang, Puyue Zhang, Ziwei Wang, Xuejiao Chang, Pengfei Lu, Yuxiang Zhang, Guoyao Sang.

   Objective: To investigate the clinical value of urinary N-telopeptide (NTx) of type I collagen in diagnosing bone metastasis (BM) from lung cancer and to optimize a multi-indicator combined detection strategy.
Methods: The study enrolled patients from a healthy control group, a lung cancer without bone metastases (LC-nonBM) group, and a lung cancer with bone metastases (LC-BM) group. The diagnostic performance of NTx-to-creatinine ratio (NTx/Cr) was evaluated by comparing biochemical indicators, staging characteristics, and receiver operating characteristic (ROC) curve analysis.
Results: NTx/Cr showed statistically significant differences across various stages within the LC-nonBM group (P = 0.004). In the LC-BM group, NTx/Cr levels were significantly elevated (P < 0.001) and positively correlated with the number of bone metastatic lesions. ROC curve analysis revealed that NTx/Cr alone achieved an areas under the curve (AUC) of 0.78 for diagnosing bone metastasis, while the three-indicator combination of the urinary NTx/Cr, serum alkaline phosphatase (ALP), and calcium (Ca) reached an AUC of 0.882, indicating a marked improvement in diagnostic performance.
Conclusion: Urinary NTx/Cr is an effective biomarker for diagnosing bone metastasis in lung cancer, and its level is closely associated with tumor stage and metastatic burden. A multi-indicator diagnostic model combining NTx/Cr, ALP, and Ca significantly enhances diagnostic accuracy.

Keywords:  Alkaline phosphatase; Bone metabolic markers; Bone metastasis; Calcium; Lung cancer; Urinary NTx

DOI:  https://doi.org/10.1016/j.jbo.2026.100784
Front Med (Lausanne). 2026 ;13 1897474

Spinal metastases in geriatric patients: a retrospective single-center comparison of mortality and surgical outcomes following neurosurgical treatment.

Saif-Eldin Abedellatif, Marija Janjic, Logman Khalafov, Harun Asoglu, Juliane Dittmer, Haitham Alenezi, Ivan Maiseyeu, Mohammed Jaber, Muriel Heimann, Tim Lampmann, Matthias Schneider, Hartmut Vatter, Motaz Hamed, Mohammed Banat.

   Background: Spinal metastases (SM) are increasingly common. In an aging population, this trend raises concerns regarding the safety and efficacy of surgical treatment (ST) in geriatric patients. This study aimed to compare postoperative outcomes, complications, recurrence, readmission, and mortality between geriatric and non-geriatric patients undergoing ST for SM.
Methods: Our retrospective cohort study included 277 patients who underwent ST for SM between 2012 and 2024. Patients were stratified into non-geriatric (< 70 years, n = 161) and geriatric (≥ 70 years, n = 116) groups. Clinical and surgical parameters, including complications, recurrence, readmission, and survival, were analyzed.
Results: Geriatric patients had a higher preoperative comorbidity burden and lower functional status. However, early outcomes, such as postoperative complications, readmission rates, and local tumor recurrence, did not differ significantly between age groups. Median overall survival was 12.0 months in patients < 70 years and 10.5 months in patients ≥ 70 years (p = 0.026). The multivariable analysis shows that obesity (p = 0.028), Surgical stabilization (p = 0.043), prolonged postoperative mechanical ventilation (p = 0.041), early surgical complications (p = 0.009), and a preoperative Karnofsky Performance Scale < 70% (p = 0.036) were independently associated with increased 1-year mortality in geriatric patients.
Conclusion: Our data demonstrates that geriatric patients undergoing ST for SM did not experience worse early postoperative outcomes. Careful patient selection based on functional status and perioperative risk factors remains essential.

Keywords:  geriatric patients; mortality; neurosurgical procedures; postoperative complications; spinal metastases; survival analysis; treatment outcome

DOI:  https://doi.org/10.3389/fmed.2026.1897474
Rev Bras Ortop (Sao Paulo). 2026 Jun;61(3): s00461824731

[Evolution of Surgical Outcomes in Spinal Metastases from Solid Tumors: A Comparative Analysis over 2 Decades].

Fernando Pacheco Dos Santos Ferreira da Silva, Pedro Reggiani Anzuatégui, Ana Valéria Rigolino Teixeira, Fernanda Pinto Garcia, Lucas Emanuel Sauer Larocca, Glauco José Pauka Mello.

   Objective: To evaluate the evolution of surgical outcomes in patients undergoing surgery for spinal metastases from solid tumors over more than two decades in a single tertiary referral center.
Methods: The present retrospective comparative study included 2 cohorts of patients who underwent surgical treatment for spinal metastases: cohort 1 (2002-2015) and cohort 2 (2018-2024). Overall survival was estimated using the Kaplan-Meier method and compared with the log-rank test. Major postoperative complications (grades III-IV) were analyzed per patient and compared between cohorts.
Results: A total of 301 patients were included (175 in cohort 1 and 126 in cohort 2). The more recent cohort demonstrated significantly improved overall survival (log-rank p < 0.001), with a hazard ratio for mortality of 0.61 (95%CI: 0.48-0.78) compared with the earlier cohort. Early survival at 30 and 90 days also improved in cohort 2. Overall complication rates were similar between groups; however, cohort 2 showed a significant reduction in local complications.
Conclusion: Surgical outcomes for spinal metastases improved over time, particularly in early survival and the reduction of local complications. These findings suggest that refinement in patient selection, prognostic stratification, and multidisciplinary perioperative care may have contributed to this temporal improvement.

Keywords:  mortality; neoplasm metastasis; postoperative complications; spine/surgery; survival

DOI:  https://doi.org/10.1055/s-0046-1824731
Mol Imaging Biol. 2026 Jul 30.

Challenges of Bone Scintigraphy in Assessment of Osseous Metastases in Prostate Cancer: Why it is Time to Reconsider Role of 1⁸F-NaF PET/CT.

Mahdi Zirakchian Zadeh.

  Evaluation of suspected bone lesions is routinely performed during the course of treatment in patients with prostate cancer, particularly in those presenting with bone pain or other clinical concern for disease progression. In the United States, technetium-99 m-labeled methylene diphosphonate (⁹⁹ᵐTc-MDP) bone scintigraphy is predominantly performed for these indications, largely due to its widespread availability, established clinical workflows, and reliable insurance reimbursement. However, 1⁸F-NaF PET/CT offers higher sensitivity for detecting bone metastases and improved differentiation between malignant and degenerative skeletal changes compared with conventional bone scintigraphy. Although bone scans are often considered lower in radiation dose, their limited specificity frequently necessitates additional imaging, such as same-day diagnostic CT or SPECT/CT, thereby increasing cumulative radiation exposure and resource utilization. In contrast, 1⁸F-NaF PET/CT provides comprehensive whole-body skeletal assessment in a single examination with shorter acquisition time. Several studies also suggest that 1⁸F-NaF PET may detect additional or more extensive osseous lesions compared with other tracers, including PSMA-targeted agents, in selected clinical contexts. Given the substantial clinical implications of underestimating skeletal disease burden, these findings further support reconsideration of the role of 1⁸F-NaF PET/CT in contemporary prostate cancer imaging.

Keywords:   1⁸F-Sodium fluoride (1⁸F-NaF) PET/CT; Bone metastases; Osteoblastic activity; PSMA PET; Prostate cancer; Technetium-99 m methylene diphosphonate (⁹⁹ᵐTc-MDP)

DOI:  https://doi.org/10.1007/s11307-026-02128-2
Zhonghua Wai Ke Za Zhi. 2026 Jul 28. 64(9): 925-931

[Expert consensus on surgical management of pelvic metastatic tumors (2026 edition)].

Bone Tumor Group of the Orthopedics Branch of the Chinese Medical Association

The pelvis is one of the common sites of metastatic tumors. Due to the wide variety of primary tumor origins and differences in tumor malignancy and the degree of bone destruction, clinical decision-making for pelvic metastatic tumors is complex, and there is a lack of unified diagnostic and treatment guidelines both domestically and internationally. To standardize the surgical treatment of pelvic metastatic tumors in China, the Bone Tumor Group of the Orthopedics Branch of the Chinese Medical Association and the Professional Committee on Bone Tumors and Bone Metastasis of the China Anti-Cancer Association organized renowned bone tumor experts in China to develop this consensus based on existing evidence and clinical experience, using a modified Delphi method. This consensus provides recommendations on core clinical issues, including preoperative evaluation, surgical approaches, postoperative rehabilitation, and perioperative management, aiming to offer practical guidance for clinical practitioners and ultimately improve patient outcomes.

DOI: https://doi.org/10.3760/cma.j.cn112139-20260605-00251
Am J Hosp Palliat Care. 2026 Jul 30. 10499091261475299

Temporal Trajectories of Emotional Well-Being and Quality of Life in Patients Presenting With Metastatic Spinal Cord Compression: A Prospective Observational Study.

Anjali P Govind, Anuja Pandit, Prashant Sirohiya, Rajeev Kumar Malhotra, Sushma Bhatnagar, Seema Mishra.

  PurposeMetastatic spinal cord compression (MSCC) is a debilitating complication of advanced malignancies, associated with immense physical and emotional distress. The aim of this study was to assess the trajectory of emotional well-being (primary outcome) and quality of life (QoL), functional status, and pain (secondary outcomes) over 30 days.Methods106 MSCC patients were included in this prospective observational study. Assessments were done using the Hospital Anxiety and Depression Scale (HADS) for emotional well-being, EORTC QLQ-C30 for QoL, Karnofsky Performance Status (KPS) for functional status, and the numeric rating scale (NRS) for pain. These were conducted at baseline (T0), day 10 (T10), and day 30 (T30).ResultsThe mean age of the participants was 54.1 years. A V-shaped pattern was observed in emotional well-being; improvement in HADS was noted from T0 to T10 (P < 0.001), but they worsened by T30 (P < 0.01). Global health and functional domains of QoL (P < 0.05) showed improvement, but these gains plateaued as fatigue and financial distress increased. Baseline correlation weakened over time between QoL and functional domains. At T30, the only domain that remained significantly associated with QoL was emotional functioning, underscoring its strong link to overall QoL. The pain decreased significantly by day 10.ConclusionMSCC affects the emotional well-being and QoL. Initial improvements in psychological symptoms is followed by an eventual decline. There is a paradox wherein, despite objective health deterioration there is subjective improvement in well-being. Hence, a multidisciplinary approach, involving psychological and rehabilitative support, becomes crucial for optimal patient-centred care.

Keywords:  anxiety and depression; emotional well-being; functional status; metastatic spinal cord compression; palliative care; quality of life

DOI:  https://doi.org/10.1177/10499091261475299
Curr Treat Options Oncol. 2026 Jul 27. pii: 39. [Epub ahead of print]27(1):

Current Treatment Options and Emerging Technologies for Pelvic Bone Tumors: From Limb Salvage to Precision Oncology.

Yichen Liu, Ziang Zhang, Chaoyang Jiang, Ke Jia, Yue Shen, Hongzhi Hu, Baichuan Wang.

   OPINION STATEMENT: In our practice, the treatment of pelvic bone tumors should begin with a multidisciplinary sarcoma-board evaluation that integrates biopsy-proven histology, high-resolution CT/MRI/PET imaging, neurovascular and visceral involvement, Enneking zone, expected survival, and patient-specific functional goals. For potentially curable primary pelvic sarcomas, we consider negative-margin resection the non-negotiable oncologic priority. Limb-salvage internal hemipelvectomy is preferred when an R0 resection can be achieved while preserving limb viability and a meaningful postoperative function; external hemipelvectomy should be reserved for tumors with unreconstructable femoral or iliac vessel involvement, extensive sciatic or lumbosacral plexus invasion, uncontrolled infection, or recurrent disease in which safe margins cannot otherwise be obtained. Histology should drive sequencing: osteosarcoma and Ewing sarcoma generally require effective neoadjuvant systemic therapy before definitive local treatment, whereas conventional chondrosarcoma requires meticulous wide en bloc surgery because chemotherapy and conventional radiotherapy have limited curative value. Reconstruction should not be selected by technology alone. For non-weight-bearing or palliative defects, no reconstruction, flail hip, hip transposition, or standard metastatic acetabular procedures may offer the best time-adjusted quality of life. For long-term survivors with periacetabular, sacroiliac, or spinopelvic instability, we favor anatomy-restoring reconstruction using navigation-assisted resection and carefully planned biological, modular, or patient-specific 3D-printed implants, provided soft-tissue coverage and infection risk are acceptable. Emerging tools such as computer-assisted navigation, robotics, artificial intelligence-based segmentation, liquid biopsy, digital twins, and smart biomaterials should be used to reinforce classic oncologic principles rather than replace them. Their adoption should depend on validated margin benefit, durable functional gain, complication reduction, cost-effectiveness, and equitable access.

Keywords:  Limb-salvage surgery; Multidisciplinary management; Pelvic bone tumors; Pelvic reconstruction; Precision oncology

DOI:  https://doi.org/10.1007/s11864-026-01406-z
Rev Bras Ortop (Sao Paulo). 2026 Jun;61(3): s00461824730

Evolution of Surgical Outcomes in Spinal Metastases from Solid Tumors: A Comparative Analysis over 2 Decades.

Fernando Pacheco Dos Santos Ferreira da Silva, Pedro Reggiani Anzuatégui, Ana Valéria Rigolino Teixeira, Fernanda Pinto Garcia, Lucas Emanuel Sauer Larocca, Glauco José Pauka Mello.

   Objective: To evaluate the evolution of surgical outcomes in patients undergoing surgery for spinal metastases from solid tumors over more than two decades in a single tertiary referral center.
Methods: The present retrospective comparative study included 2 cohorts of patients who underwent surgical treatment for spinal metastases: cohort 1 (2002-2015) and cohort 2 (2018-2024). Overall survival was estimated using the Kaplan-Meier method and compared with the log-rank test. Major postoperative complications (grades III-IV) were analyzed per patient and compared between cohorts.
Results: A total of 301 patients were included (175 in cohort 1 and 126 in cohort 2). The more recent cohort demonstrated significantly improved overall survival (log-rank p < 0.001), with a hazard ratio for mortality of 0.61 (95%CI: 0.48-0.78) compared with the earlier cohort. Early survival at 30 and 90 days also improved in cohort 2. Overall complication rates were similar between groups; however, cohort 2 showed a significant reduction in local complications.
Conclusion: Surgical outcomes for spinal metastases improved over time, particularly in early survival and the reduction of local complications. These findings suggest that refinement in patient selection, prognostic stratification, and multidisciplinary perioperative care may have contributed to this temporal improvement.

Keywords:  mortality; neoplasm metastasis; postoperative complications; spine/surgery; survival

DOI:  https://doi.org/10.1055/s-0046-1824730
Cancers (Basel). 2026 Jul 08. pii: 2199. [Epub ahead of print]18(14):

Postoperative MRI Artifact Burden After Carbon Fiber-Reinforced PEEK Versus Titanium Instrumentation in Metastatic Spinal Disease.

Kamil Krystkiewicz, Aleksander Kowal, Agata Krajniak, Michał Dziatosz, Mateusz Bilski, Łukasz Kuncman, Marcin Tosik.

   BACKGROUND/OBJECTIVES: Patients undergoing surgery for metastatic spinal disease often require instrumented stabilization followed by radiotherapy and postoperative magnetic resonance imaging (MRI) surveillance. Titanium implants may generate artifacts that impair assessment of the operated level, whereas carbon fiber-reinforced polyetheretherketone (CFR-PEEK) constructs may improve MRI assessability. This study compared CFR-PEEK and titanium instrumentation with respect to postoperative MRI artifact burden, early outcomes, and oncological follow-up, and introduced a study-specific artifact grading system.
METHODS: This retrospective single-center cohort included 78 patients treated with instrumented stabilization for metastatic spinal disease: 33 with CFR-PEEK and 45 with titanium instrumentation. Postoperative MRI suitable for artifact assessment was available in 47 patients. Implant-related artifacts were evaluated using the Oncologic Spinal Instrumentation MRI Artifact Score (O-SIMAS), a 0-5 anatomy-based grading system. Early postoperative outcomes, local recurrence, progression-free survival, overall survival, and interrater agreement were analyzed.
RESULTS: CFR-PEEK instrumentation was associated with lower postoperative MRI artifact burden than titanium instrumentation, with median O-SIMAS scores of 2.0 versus 3.0, respectively (p < 0.001). High-grade artifacts were less frequent after CFR-PEEK than after titanium instrumentation (15.8% versus 67.9%; p = 0.0008). Titanium instrumentation remained independently associated with high-grade artifacts. Early postoperative outcomes, local recurrence, progression-free survival, and overall survival did not differ significantly between groups. O-SIMAS showed substantial pairwise interrater agreement.
CONCLUSIONS: CFR-PEEK instrumentation was associated with improved postoperative MRI assessability and fewer diagnostically relevant artifacts than titanium instrumentation. No oncological benefit was shown. O-SIMAS may support structured artifact assessment, but requires external validation.

Keywords:  MRI artifacts; carbon-fiber implants; oncologic spinal instrumentation MRI artifact score; postoperative MRI; spinal metastases; titanium instrumentation

DOI:  https://doi.org/10.3390/cancers18142199
Biomolecules. 2026 Jul 16. pii: 1039. [Epub ahead of print]16(7):

Proteoglycans as Molecular Regulators of Bone Metastasis: Extracellular Matrix Remodeling, Tumor-Bone Crosstalk, Dormancy, and Therapeutic Opportunities.

Zoila Mora Guzmán, Ibzan Jahzeel Salvador Ibarra, Patricia Juárez, Anahí Jobeth Borrás Enríquez, Edmar de Jésús Díaz García, Hector Alejandro Cabrera-Fuentes, María Teresa Hernández-Huerta.

  Background: Bone metastasis is a frequent and debilitating complication of advanced cancer, particularly in breast and prostate cancer, and is driven by complex interactions among tumor cells, bone-resident cells, immune populations, vascular components, and the extracellular matrix. Within this specialized microenvironment, proteoglycans have emerged as key molecular regulators of tumor-bone crosstalk, matrix remodeling, metastatic niche formation, dormancy, and therapeutic resistance. Methods: We conducted a narrative review using targeted searches of PubMed and Google Scholar for studies published through 31 May 2026. Search terms included combinations of proteoglycan- and glycosaminoglycan-related concepts, including "proteoglycans," "glycosaminoglycans," "heparan sulfate proteoglycans," "hyaluronan," "heparanase," "syndecans," "glypicans," "perlecan/HSPG2," "versican," and "decorin," with disease- and process-related terms such as "bone metastasis," "extracellular matrix," "tumor-bone crosstalk," "breast cancer," "prostate cancer," "metastatic niche," "osteolytic metastasis," "osteoblastic metastasis," "dormancy," "reactivation," "immune regulation," and "therapy resistance." Original studies, reviews, and translational reports were selected according to their relevance to cell-surface, pericellular, and extracellular proteoglycans in bone metastatic progression. Results: Proteoglycans and associated GAG/ECM axes are implicated in multiple processes involved in skeletal metastasis, including growth factor availability, extracellular matrix organization, osteolytic and osteoblastic niche formation, angiogenesis, immune evasion, metastatic dormancy, reactivation, and therapy resistance. These functions are highly context-dependent and are influenced by proteoglycan localization, core protein structure, glycosaminoglycan composition, sulfation patterns, proteolytic processing, and cellular source. Conclusions: Proteoglycans represent critical molecular nodes in the bone metastatic microenvironment and hold potential as biomarkers, therapeutic targets, and tools for stratifying metastatic niche heterogeneity. Their clinical translation will require validation in human bone metastasis samples, improved models that reproduce the mineralized and immune-rich bone niche, and a clearer distinction between causal mechanisms and correlative associations. Future studies should integrate matrisome profiling, spatial proteomics, single-cell and spatial transcriptomics, glycosaminoglycan omics, degradomics, and three-dimensional bone niche models to define actionable proteoglycan-dependent mechanisms and improve therapeutic targeting of metastatic bone disease.

Keywords:  bone metastasis; breast cancer; decorin; extracellular matrix; hyaluronan; metastatic niche; perlecan; prostate cancer; proteoglycans; versican

DOI:  https://doi.org/10.3390/biom16071039
Clin Neurol Neurosurg. 2026 Jul 17. pii: S0303-8467(26)00271-4. [Epub ahead of print]270 109579

Comparison of survival, neurological, and radiographic outcomes between corpectomy and instrumented separation surgery for spinal metastatic disease: A single institutional experience.

Clayton Rosinski, Ajmain Chowdhury, Anthony Marincovich, Nahom Teferi, Kirill Nourski, Pujit Mekala, S Jennifer Noeller, Cassim Igram, Satoshi Yamaguchi, Patrick Hitchon.

   OBJECTIVES: Spinal metastatic disease incidence has increased due to advances in radiation and chemotherapy that improve survival. Surgical treatment includes separation surgery, for decompression of neural elements from the tumor to allow for post-operative stereotactic radiation versus maximal tumor resection via corpectomy. Data is mixed on whether more invasive corpectomy for tumor resection provides significant benefit over less invasive separation surgery.
METHODS: A retrospective review of 100 consecutive patients was performed, 60 underwent corpectomy and 40 were treated with instrumented separation surgery. Demographics, tumor characteristics, clinical and radiographic data, treatments, and outcomes were analyzed.
RESULTS: Both groups had similar baseline characteristics in terms of age, cancer type, and preoperative function. Postoperatively, both groups had similar functional outcomes while corpectomy was associated with a significant correction (p = 0.02) in kyphosis by 4 ° compared to separation surgery which was neutral (0 °). The median overall survival did not significantly differ between the two groups. Poor neurologic function was associated with shorter survival. Reoperation rate did not statistically differ between the two groups. The separation surgery group had a higher rate of reoperation for tumor progression, but it did not reach significance (p = 0.057).
CONCLUSION: Compared to separation surgery, corpectomy offers similar functional outcomes with improved segmental kyphosis correction, with possible survival benefit. However, this comes at the cost of added surgical complexity, reflected in greater operative time and need for transfusion. In the right candidate, corpectomy may be favored due to improved anterior column reconstruction and reduced oncologic burden.

Keywords:  Corpectomy; Kyphosis; Separation surgery; Spinal metastasis; Spinal oncology, outcomes

DOI:  https://doi.org/10.1016/j.clineuro.2026.109579