bims-rebome 2026-08-16 papers

J Pain Palliat Care Pharmacother. 2026 Aug 13. 1-7

Intravenous Zoledronic Acid for Bone Pain Relief in Cancer Patients with Bone Metastasis Receiving Low Dose Opioids and Nsaids: A Randomized Controlled Study.

Attiqa Choudhary, Zahida Aziz, Naine Badrala, Neha Sharma.

Bone is a frequent site of metastasis, particularly in breast, lung, prostate, and renal cancers. Skeletal metastases lead to severe pain, fractures, hypercalcemia, and reduced quality of life. Zoledronic acid(ZA), a potent intravenous bisphosphonate, inhibits osteoclast-mediated bone resorption and may reduce metastatic bone pain. This study assessed the efficacy and safety of intravenous zoledronic acid in relieving bone pain in patients with bone metastases receiving standard analgesics. In this randomized prospective controlled study, out of 120, 70 adults aged 30-70 years with confirmed bone metastases and visual analog score of >4 who completed the follow up were enrolled. Patients were randomized into two groups (35 each), Group Z received ZA 4 mg intravenously (every 4 wk) along with low-dose morphine 5 mg every 4 h and tablet etoricoxib 60 mg twice daily and Group P received tab morphine 5 mg every 4 h and tab etoricoxib 60 mg twice daily. All patients received calcium and vitamin D supplementation. Weekly assessments included BPI scores, skeletal-related events, and adverse effects. Patients receiving intravenous ZA demonstrated significantly greater reductions in pain severity and fewer skeletal-related events than Group P (p < 0.05). No serious drug-related adverse effects were noted.

Keywords: Bone metastasis; Zoledronic acid; bisphosphonates; cancer pain; palliative care

DOI: https://doi.org/10.1080/15360288.2026.2718825

Int J Breast Cancer. 2026 ;2026 7130498

Survival and Predictors in Patients With Breast Cancer Undergoing Surgery for Spinal Metastases: Insights From a Single-Center Cohort.

Leonardo Olijnyk, Vivian Huong Hoang Thien Le, Edisond Florial, Fidaa Al-Shakfa, Jean-Marc Mac-Thiong, Maroun Rizkallah, Ghassan Boubez, Jesse Shen, Zhi Wang.

Background: Breast cancer is the most commonly diagnosed malignancy among women globally, with spinal metastases significantly impacting morbidity and mortality. Surgical intervention plays a crucial role in managing symptomatic spinal lesions, yet prognostic factors and outcomes remain areas of active investigation. This study aims to evaluate survival rates and identify predictors in patients with breast cancer undergoing surgery for spinal metastases.
Methods: A retrospective analysis was conducted on 97 patients who underwent surgery for spinal breast cancer metastases at a single center over a 12-year period. Data included epidemiological and preoperative profiles, biological markers, and radiological findings. Survival outcomes were assessed using Kaplan-Meier analysis, and prognostic factors were analyzed via Cox regression.
Results: Postoperative overall survival rates were 72%, 64%, and 34% at 1, 2, and 5 years, respectively. Significant predictors of survival included tobacco use (HR 1.7, p = 0.025), estrogen receptor (HR 0.224, p = 0.03), triple-negative subtype (HR 4.1, p < 0.01), and lower Karnofsky scores (HR 0.488, p < 0.01). Spinal instability and preoperative neurological status did not significantly influence survival. Complications occurred in 17% of patients, with no 30-day mortality.
Conclusion: This study provides one of the largest single-center experiences of surgery for spinal metastases from breast cancer in the modern treatment era. We found that overall preoperative performance and biological markers, remains a key predictor of survival, while neurological status, disease spread and spinal instability have no impact than in long-term survival. These results reflect advances in systemic therapy and surgical care, supporting surgery as an important part of multidisciplinary management for selected patients.

Keywords: breast cancer; oncology spine surgery; prognostic factors; spinal metastases

DOI: https://doi.org/10.1155/ijbc/7130498

Nucl Med Commun. 2026 Aug 14.

Safety profile of therapeutic radiopharmaceuticals for bone metastases pain palliation: evidence from a systematic literature review.

Sara Martins, Diana Oliveira, Cláudia Pinho, Ana Martín-Suárez, Ângelo Jesus.

Radiopharmaceutical therapy is one of the treatment modalities used for the palliative management of pain associated with bone metastases. Given that radiopharmaceuticals may cause adverse reactions, this study aims to systematize the findings of published research on the use of strontium-89, samarium-153, rhenium-186, rhenium-188, and lutetium-177 in this clinical context. Adverse reactions were analyzed through a two-part approach. The first section presents a systematic literature review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement, using the MEDLINE and EBSCO databases, from which 29 articles were selected. Findings indicate that the four radiopharmaceuticals yielded broadly comparable results across pain relief, reduction in analgesic consumption, acute administration-related adverse reactions, hematological toxicity, and disease progression. The second section critically appraises the methodological quality of the included publications, using a structured assessment tool. Results indicate that, although therapeutic radiopharmaceuticals generally demonstrate a favorable safety profile, hematological toxicity, particularly leukopenia and thrombocytopenia, is the most frequently reported adverse reaction. The spontaneous reporting system continues to face significant challenges, including data limitations in vulnerable populations, conflicting causality assessments, and underreporting. In conclusion, the use of radiopharmaceuticals for pain palliation appears to be safe and represents a viable alternative to existing treatments. This work underscores the importance of integrating pharmacovigilance practices specific to radiopharmaceuticals, promoting structured adverse reactions reporting, and enhancing clinical awareness to safeguard patient safety.

Keywords: adverse reactions; bone metastases; pain palliation; pharmacovigilance; radiopharmaceuticals

DOI: https://doi.org/10.1097/MNM.0000000000002221

Int J Mol Sci. 2026 Jul 29. pii: 6805. [Epub ahead of print]27(15):

Phylogeography of Bone Metastasis: Clonal Evolution, Skeletal Niche Adaptation, and Clinical Implications.

Samaa Alotab, Rasha Alissa, Mariam Zainab, Labibah Labib Khamies, Khalid Said Mohammad.

Bone metastasis is often treated clinically as a late complication of advanced cancer, yet accumulating evidence indicates that it is also a spatial evolutionary process shaped by clonal selection, niche adaptation, dormancy, and reseeding. This review examines BoM through a phylogeographic framework that links tumor ancestry with anatomical location and time. We discuss how heterogeneous primary tumors generate bone-tropic subclones, how circulating tumor cells pass through dissemination bottlenecks, and how disseminated tumor cells enter perivascular and endosteal niches that either maintain dormancy or support early micrometastatic outgrowth. We then compare clonal architectures across breast, prostate, lung, and renal cell carcinomas, emphasizing both lineage-specific programs and convergent bone-adaptive states, including osteomimicry, immune evasion, metabolic plasticity, and epigenetic remodeling. Methodological platforms such as multiregion sequencing, single-cell and spatial transcriptomics, lineage tracing, and liquid biopsy are evaluated with attention to the technical limitations imposed by mineralized tissue. Finally, we consider how bone lesions may function as reservoirs for secondary dissemination and how evolutionary thinking could improve biomarker development, dormancy prediction, trial design, and therapy selection. Viewing BoM as an evolving ecosystem may help shift the field from reactive skeletal management toward earlier, biology-informed intervention.

Keywords: bone metastasis; bone microenvironment; clonal evolution; disseminated tumor cells; phylogeography; tumor dormancy

DOI: https://doi.org/10.3390/ijms27156805

J Neurosurg Spine. 2026 Aug 14. 1-11

Impact of oncological biomarkers and clinical factors on survival outcomes in renal cell carcinoma with spinal metastasis: a retrospective analysis.

Joseph Rajasekaran, Xinlan Yang, Abdul Karim Ghaith, Zhehao Zhang, Abdel-Hameed Al-Mistarehi, Taha Khalilullah, Avi N Albert, Kristin J Redmond, Nicholas Theodore, Daniel Lubelski.

OBJECTIVE: Renal cell carcinoma (RCC) is a common malignancy that metastasizes to the spine, leading to complex treatment challenges and reduced survival. The aim of this study was to evaluate the prevalence of oncological biomarkers in patients with RCC spinal metastasis and analyze how these biomarkers, along with clinical factors, impact survival outcomes.
METHODS: This retrospective cohort study included patients with RCC spinal metastasis who were treated surgically at a single academic center between 2013 and 2024. Clinical, surgical, and treatment data were collected. Immunohistochemical analysis of the 10 most prevalent biomarkers was performed on spinal tumor specimens. Predictive modeling of overall mortality was conducted using multivariate logistic regression, decision tree, and random forest algorithms. Model performance was assessed using the area under the curve, and key interactions were identified through interaction depth analysis. Unsupervised clustering was used to stratify patients into biomarker-defined risk groups.
RESULTS: Thirty-six patients (mean age 60 years) were included in the analysis. The overall mortality rate was 61.1%, with a mean follow-up duration after diagnosis of spinal metastasis of 16.1 months. CK7 and AE1/AE3 were the most significant predictors of mortality, with CK7-positive and AE1/AE3-negative patients having an 80% mortality rate versus 25% in AE1/AE3-positive patients (p < 0.01). CAM5.2 and KRAS expression were associated with 100% and 80% mortality, respectively. Patients with EGFR positivity and CK7 negativity had 0% mortality (p = 0.01). Decision tree analysis identified CAM5.2, CK7, and AE1/AE3 as key hierarchical classifiers. In the random forest analysis, CK7 and AE1/AE3 (mean minimal depths of 2.04 and 2.34, respectively) had the highest variable importance scores (Gini p < 0.01) (area under the curve: logistic regression = 0.74; decision tree = 0.72; random forest = 0.81). Unsupervised clustering stratified patients into three molecular subgroups with distinct mortality risks: cluster 1 (61.5%), cluster 2 (50.0%), and cluster 3 (66.7%).
CONCLUSIONS: Immunohistochemical biomarkers, particularly CK7, AE1/AE3, CAM5.2, and EGFR, hold significant prognostic value in RCC spinal metastasis and can help stratify patients into high- and low-risk groups. The integration of these biomarkers into tree-based machine learning models provides interpretable data-driven decision tools to support personalized surgical and systemic treatment planning. These findings warrant validation in larger multi-institutional prospective cohorts and further analysis of biomarker interactions.

Keywords: biomarkers; cervical; lumbar; oncology; renal cell carcinoma; sacral; spine; survival; thoracic; tumor

DOI: https://doi.org/10.3171/2026.3.SPINE251351

J Mech Behav Biomed Mater. 2026 Jul 31. pii: S1751-6161(26)00246-8. [Epub ahead of print]183 107577

Patient-specific finite element models of human vertebrae with simulated osteolytic defects: Predictive accuracy of surface strain and endplate deflection.

Giulia Fraterrigo, Enrico Schileo, Paolo Erani, Alessandro Gasbarrini, Luigi Falzetti, Cristina Bignardi, Fulvia Taddei, Massimiliano Baleani.

Approximately 40% of cancer patients develop spinal metastases, often leading to vertebral fragility fractures. Osteolytic metastases are the most severe, as they significantly alter strain distribution in bone tissue. This pilot study extends a previously validated experimental-computational framework for intact vertebrae to assess the accuracy of personalized finite element models (FEM) in the presence of controlled artificial lytic defects. Three human lumbar vertebrae (L3-L5) were tested in intact and defect conditions. Progressively enlarging hemispherical defects (10-25 mm diameter) were drilled within the trabecular bone through the caudal surface after endplate removal, without involving the cortical wall. A compressive load of 2 kN was homogeneously distributed on the cranial endplate. Surface displacements and strains were measured using Digital Image Correlation (DIC), and cranial endplate deflection using a linear displacement transducer (LVDT). Corresponding FEM were developed from CT data and validated against experimental measurements. Predicted and measured endplate deflection (R2 = 0.79) and vertebral wall displacements (R2 = 0.87-0.92) were significantly correlated across all defect sizes. Longitudinal strain predictions demonstrated good agreement with experimental data, with median relative errors across defect sizes ranging from -4% to +13%, comparably to the intact condition (+10%). Circumferential strains in defect conditions were consistently overestimated, similarly to the intact condition as well. In summary, the proposed FEM retained high accuracy in longitudinal strain prediction and captured vertebral endplate deflection even in the presence of large trabecular defects, although experimental limitations suggest modifying the caudal constraint in future studies.

Keywords: Computed tomography; Digital image correlation; Finite element models; Human vertebrae; Mechanical testing; Osteolytic lesions; Validation

DOI: https://doi.org/10.1016/j.jmbbm.2026.107577