bims-rebome 2026-09-06 papers

bims-rebome

Biomed News

on Management of bone metastases

Issue of 2026–09–06
ten papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata

What Is the 5-year Survival of Patients With or Without Surgery in Spinal Metastatic Disease?
Timing of bone-modifying agent initiation and skeletal-related event risk in patients with bone metastases from solid tumors: a retrospective landmark and propensity score-matched analysis.
[Evolution and prospect of treatment decision-making systems for spinal metastases:from traditional frameworks to the era of precision medicine].
CX3CL1/CX3CR1 signaling in spinal metastasis: mechanisms and translational opportunities.
Chapter - Follow-up and Functional Scores: PROMs.
Surgery of the tumors of the spine.
Tumor Destructive Mechanical Impulse (TMI) Treatment of Solid Tumors. Part IV: Palliative Management of Painful Bone Metastases, Pain Relief - and Beyond.
Different Acupuncture Combined With Three-Step Analgesic Therapy in the Treatment of Bone Metastatic Cancer Pain: A Network Meta-Analysis Based on Randomized Controlled Trials.
The role of stereotactic radiosurgery for prostate cancer spine metastasis - impact on hormone sensitivity and treatment outcomes: a systematic review of literature.
Efficacy and Safety of Stereotactic Body Radiation Therapy for Metastatic Bone Tumors in Clinical Practice.

Clin Orthop Relat Res. 2026 Aug 31.

What Is the 5-year Survival of Patients With or Without Surgery in Spinal Metastatic Disease?

Brendan M Striano, Kaitlyn E Holly, Alyssa L Schoenfeld, Amelia Osgood, Joshua M Coan, Patrick K Cronin, Marco L Ferrone, Andrew J Schoenfeld, Daniel G Tobert.

BACKGROUND: Despite advances in imaging, nonoperative management, immunotherapy, and surgery over the last 15 years, sizable improvements in survival for patients with spinal metastases have not been observed. Older studies may no longer be accurate in light of rapid technological improvements. The performance of scoring utilities, such as the Skeletal Oncology Research Group (SORG) nomogram and the New England Spinal Metastasis Score (NESMS), has also not been investigated beyond the first year of treatment.
QUESTIONS/PURPOSES: (1) What was the 5-year survival of patients who presented with spinal metastases and were treated with or without surgery according to contemporary indications, stratified by tumor type? (2) How effective were the SORG and NESMS at prognosticating survival up to 5 years after presentation?
METHODS: We used our healthcare system's registry to identify patients treated operatively and nonoperatively for spinal metastatic disease (full surveillance inclusive of follow-up from January 1, 2017 to December 31, 2025). Data included in this study were drawn from two large, tertiary academic hospitals in a single major city, as well as from two local affiliate community hospitals. This study environment allowed for capturing a broad sample of tumor and treatment types, which is representative of the complex care associated with spinal metastatic disease. Query of the registry identified 997 patients; 71 patients were excluded because their initial presentation was < 5 years from the final data date; they were therefore ineligible for 5-year evaluation. Those whose initial presentation was < 5 years from study initiation, but had died, were maintained. One percent of patients (13 of 926) were eligible for 5-year follow-up but had an unknown vital status. Missing data were uncommon, with no variable having > 1% missingness. Sixty percent (551) of patients were treated with surgery. Overall, the surgical and nonoperative cohorts were comparable regarding demographic and clinical characteristics. Patients treated with surgery were slightly older than those treated nonoperatively (62 years versus 59 years; p < 0.01). The nonoperative cohort had a female predominance, whereas the surgical cohort did not (56% versus 43%; p < 0.001). Both cohorts had a median CCI score of 8 (p = 0.7). There were no differences in the use of immunotherapy between those treated with surgery (29%) and those treated with nonoperative care (27%; p = 0.6). We evaluated survival over the course of 5 years after presentation. In this registry, death is captured through a combination of medical record documentation as well as linkage to external state and federal sources. We performed multivariable Cox proportional hazards regression analysis for 5-year survival using each spinal metastasis prognostic score. The SORG is a prognostic score from 0 to 100 that represents the calculated probability of survival. NESMS ranges from 0 to 3, with higher scores representing a more favorable clinical state. Separate models were generated using SORG and NESMS as the primary explanatory variable, respectively. Both models adjusted for age, sex, race, comorbidity burden, immunotherapy, and surgical treatment.
RESULTS: At the 5-year time point, the Kaplan-Meier survival estimate was 8.9% (95% confidence interval [CI] 7.2% to 10.9%). Patients with lung cancer demonstrated the lowest survival rate among the discrete tumor types at every time point. When accounting for age, sex, race, comorbidities, immunotherapy, and treatment type, the SORG score was associated with survival (HR 0.98 [95% CI 0.98 to 0.99]; p < 0.001), meaning that each single-point increase in SORG score was associated with a 2% decreased likelihood of mortality. When controlling for the same variables, the NESMS was also associated with 5-year survival (HR 0.61 [95% CI 0.56 to 0.66]; p < 0.001), meaning that each 1-point increase in SORG score was associated with 40% reduction in mortality.
CONCLUSION: We present long-term survival for patients with spinal metastases in the modern period of spine oncology care, stratified by primary cancer type. Although mortality rates over time remain high, our study is the first to show that approximately 10% of patients will survive 5 years or longer. These data can aid in patient counseling as well as surgical decision-making. Understanding the 5-year survival forecast for patients with spinal metastases will help physicians tailor treatment decisions and can help surgeons prioritize minimizing surgical morbidity with shorter, simpler operations, when possible. Both the SORG and NESMS can be used to support long-term estimations regarding survival.
LEVEL OF EVIDENCE: Level III, therapeutic study.

DOI: https://doi.org/10.1097/CORR.0000000000004114
Support Care Cancer. 2026 Sep 03. pii: 925. [Epub ahead of print]34(10):

Timing of bone-modifying agent initiation and skeletal-related event risk in patients with bone metastases from solid tumors: a retrospective landmark and propensity score-matched analysis.

Tatsuki Ikeda, Satoru Nihei, Kazuki Saito, Junya Sato, Kenzo Kudo.

   PURPOSE: The optimal timing for initiating bone-modifying agents (BMAs) after the diagnosis of bone metastasis remains unclear. We evaluated the association between the timing of BMA initiation and the subsequent risk of skeletal-related events (SREs).
METHODS: Patients with solid tumors who received BMA therapy for bone metastasis at a single institution between 2010 and 2024 were retrospectively analyzed. To minimize immortal time bias, a landmark analysis was performed at 6 months after the diagnosis of bone metastasis. Patients who remained under follow-up and had not experienced an SRE by the landmark were classified into the Early group if BMA therapy was initiated by the landmark; otherwise, they were assigned to the Delayed group. One-to-one propensity score matching (PSM) was performed to balance baseline characteristics between the groups. The primary endpoint was the time from the landmark to the first SRE.
RESULTS: Following PSM, 134 patients were included in each group. SREs were observed in 86 patients during follow-up after the landmark. The Delayed group had a significantly higher subsequent risk of SREs than the Early group (hazard ratio (HR), 1.82; 95% confidence interval (CI), 1.16-2.84; P < 0.01).
CONCLUSIONS: Among patients who remained under follow-up and SRE-free at the 6-month landmark, delayed BMA initiation was associated with a higher subsequent risk of SREs than early initiation. Thus, prolonged delay in BMA initiation after the diagnosis of bone metastasis may be clinically relevant to subsequent SRE risk.

Keywords:  Bone metastases; Bone-modifying agents; Landmark analysis; Propensity score matching; Skeletal-related events

DOI:  https://doi.org/10.1007/s00520-026-11136-5
Zhongguo Gu Shang. 2026 Aug 25. 39(8): 836-42

[Evolution and prospect of treatment decision-making systems for spinal metastases:from traditional frameworks to the era of precision medicine].

Xuyong Cao, Yaosheng Liu.

  The treatment of spinal metastases is highly dependent on multidisciplinary collaboration. This study systematically reviews the evolution of clinical decision-making systems for spinal metastases, from traditional frameworks to the era of precision medicine. The neurologic, oncologic, mechanical, systemic(NOMS) framework, introduced in 2006, focused on surgical and radiotherapeutic interventions;however, it had notable deficiencies in its neurologic assessment grading and, in terms of oncologic management, largely overlooked the role of systemic therapy in achieving local control of bony metastatic lesions. The LMNOP (location, mechanical, neurologic, oncologic, patient) framework, proposed in 2011, attempted to explore individualized surgical approaches, but its accuracy in determining optimal strategies remained suboptimal, and it still fell short in adequately incorporating systemic therapeutic factors. In 2017, the International Spinal Oncology Consortium introduced the MNOP(mechanical, neurologic, oncologic, patient) system, which placed greater emphasis on patient survival assessment. In 2018, the Dutch guidelines standardized surgical timing and radiotherapy strategies, and in the same year, the MOSS (medical/mental, oncological, stenosis, stability) framework achieved innovations in systematic evaluation, non-surgical interventions, and the integration of psychological status. In 2021, the Department of Orthopedics at the Chinese PLA General Hospital proposed the SENO framework for spinal metastases, which encompasses four major elements:systemic conditions, effectiveness of systemic treatment of tumors, neurology, and oncology. Built upon the foundation of the ESCC Twelve-Point Grading System developed by the Chinese PLA General Hospital, the SENO framework has successfully established a novel precision comprehensive treatment model characterized by "minimally invasive intervention first, followed by systemic therapy". Clinical practice has demonstrated that the SENO framework offers significant advantages in therapeutic outcomes compared with traditional decision-making approaches. The continuous evolution of clinical decision-making systems for spinal metastases profoundly reflects the broader transformation of oncology from experience-based medicine to evidence-based medicine. Looking ahead, with the deep integration of artificial intelligence and multi-omics technologies, decision-making systems for spinal metastases are poised to advance toward a comprehensive, intelligent "prevention-intervention-rehabilitation" continuum, bringing new promise for improving patient prognosis.

Keywords:  Intelligence; NOMS framework; SENO framework; Spinal metastases; Treatment decision-making system

DOI:  https://doi.org/10.12200/j.issn.1003-0034.20250293
Clin Exp Metastasis. 2026 Aug 30. pii: 46. [Epub ahead of print]43(5):

CX3CL1/CX3CR1 signaling in spinal metastasis: mechanisms and translational opportunities.

Vivek Sanker, Zhikai Li, Adrian Urdaneta, Aaditya Dravid, Philip Heesen, Joseph Frantzias, Maria Jose Cavagnaro, John Ratliff, Irimpan Mathews, Atman Desai.

   BACKGROUND: Spinal metastases are a common and morbid complication of advanced malignancies. While vertebral involvement is often attributed to anatomical factors, emerging evidence implicates the chemokine CX3CL1 and its receptor in guiding tumor cells to the spine and reshaping the bone microenvironment.
OBJECTIVE: To systematically review the role of the CX3CL1/CX3CR1 axis in spinal metastasis from primary breast, prostate, and liver tumours, synthesizing mechanistic, preclinical, and translational findings.
METHODS: Following PRISMA guidelines, we searched Medline, EMBASE, Web of Science, and Scopus from inception to May 27, 2025, identifying original studies on CX3CL1/CX3CR1 signalling in spinal metastasis. Ten studies met inclusion criteria. Data were extracted across study design, tumour model, expression analysis, mechanisms, and therapeutic or prognostic outcomes. We also analysed experimentally determined CX3CL1 and CX3CR1 structures to identify features relevant to inhibitor design.
RESULTS: CX3CL1 expression was three-fold higher in spinal metastases than in primary tumours or non-spinal bone. Mechanistic studies showed roles in chemotaxis, Src/FAK and PI3K/AKT activation, EMT, vascular permeability, and immunomodulation. CX3CL1 also activated stromal pathways promoting osteolysis. Pharmacologic inhibition reduced spinal metastasis and restored chemosensitivity in murine models. Elevated serum CX3CL1/CX3CR1 levels correlated with disease burden in patient cohorts.
CONCLUSION: The CX3CL1/CX3CR1 axis contributes to spinal metastasis by integrating tumour-intrinsic signalling with vertebral niche remodelling, extending the seed-and‑soil hypothesis. Its consistent activity and tractability highlight its promise as both biomarker and therapeutic target in metastatic spine disease.

Keywords:  CX3CL1/CX3CR1 axis; Chemokine signaling; Spinal metastasis; Translational oncology; Tumor microenvironment

DOI:  https://doi.org/10.1007/s10585-026-10427-9
Neurochirurgie. 2026 Sep 02. pii: S0028-3770(26)00107-4. [Epub ahead of print] 101873

Chapter - Follow-up and Functional Scores: PROMs.

Benjamin Bouyer, Maxence Bessaudou.

  Spinal metastases represent a major event in the course of cancer, frequently resulting in pain, neurological impairment, reduced functional capacity, and diminished quality of life. Traditional assessment of these patients has largely relied on clinical examination, radiological findings, and prognostic scoring systems. However, these approaches may not fully capture the patient's experience of disease and treatment. Patient-reported outcome measures (PROMs) provide a standardized method for evaluating symptoms, functional status, and health-related quality of life from the patient's perspective. This chapter reviews the principal PROMs currently used in patients with spinal metastases, including generic instruments such as the Short Form-36 (SF-36), EuroQol-5 Dimension (EQ-5D), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), and the Brief Pain Inventory (BPI), as well as spine-specific tools including the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ) and the MD Anderson Symptom Inventory-Spine Tumor Module (MDASI-Spine) Particular attention is given to the Patient-Reported Outcomes Measurement Information System (PROMIS), an emerging instrument that combines strong psychometric performance with reduced respondent burden through computer adaptive testing. Current evidence suggests that PROMIS demonstrates validity and responsiveness comparable to established instruments while offering improved efficiency in clinical practice. PROMs are increasingly recognized as essential components of patient-centred care in spinal oncology. Their systematic integration into clinical research and routine practice may improve outcome assessment, support therapeutic decision-making, and ultimately enhance quality of life for patients with spinal metastases.

Keywords:  Spine Metastasis PROMS

DOI:  https://doi.org/10.1016/j.neuchi.2026.101873
EFORT Open Rev. 2026 Sep 01. 11(9): 913-929

Surgery of the tumors of the spine.

Andrea Angelini, Pietro Ruggieri.

  Spinal tumors encompass a heterogeneous group of primary and metastatic lesions requiring individualized management strategies based on tumor biology, patient prognosis, and mechanical stability. Decision-making frameworks, such as NOMS, SINS, and Tokuhashi score, provide structured guidance for selecting metastatic patients for surgery and defining individualized treatment strategies. En bloc resection remains the gold standard for selected primary malignant tumors, whereas separation surgery combined with stereotactic radiosurgery represents the cornerstone of modern metastatic spine disease management. Minimally invasive techniques represent a paradigm shift toward less invasive, patient-tailored surgical strategies in spine oncology, complementing rather than replacing traditional open approaches. Future developments in robotics, ablation technologies, and biomaterials are expected to further refine surgical precision and expand treatment indications.

Keywords:  en blocresection; metastases; minimally invasive spine surgery; navigation; separation surgery; spine tumors

DOI:  https://doi.org/10.1530/EOR-2026-0089
Cell Physiol Biochem. 2026 Sep 01. 60(5): 503-517

Tumor Destructive Mechanical Impulse (TMI) Treatment of Solid Tumors. Part IV: Palliative Management of Painful Bone Metastases, Pain Relief - and Beyond.

Axel Erich Theuer, Stella Exner, Ioannis Thomas, Florian Lang, John Warlick, John David Mullins, Thomas K Eigentler, Gerhard Franz Walter.

   BACKGROUND/AIMS: Bone metastases are a frequent and highly debilitating complication of advanced malignancies and are associated with severe pain, structural instability and loss of functional capacity. Radiotherapy, systemic antineoplastic therapy, bone-targeted agents and interventional techniques remain the clinical standard, yet a relevant proportion of patients experience only incomplete or transient pain relief. Non-invasive focal approaches are therefore being explored. Tumor-destructive mechanical impulses (TMI) - an umbrella term for shock-type, high-strain acoustic pulses generated by electrohydraulic, electromagnetic or piezoelectric systems - have a long safety record in musculoskeletal medicine and are increasingly investigated in oncology. We report the palliative use of TMI in patients with painful bone metastases.
METHODS: Patient-specific DICOM data were segmented using Simpleware ScanIP® and imported into ANSYS SpaceClaim for geometry preparation, enabling coupled device-tissue simulations under clinical pressure wave forms; the resulting anatomical models were simulated in ANSYS Explicit Dynamics. In parallel, DICOM data were processed using MATLAB®/TABLIN and converted into OnScale® for high-frequency pressure wave propagation analysis, predicting pressure fields, focal volumes and attenuation through bone. The outputs of the numerical solution of the finite element (FEM) propagation models comprise total energy, energy flux density, pulse count and frequency, and the optimal placement of the TMI applicator. TMI was applied within individual healing attempts in patients in whom conventional therapy had failed.
RESULTS: In two patients with metastatic prostate carcinoma described in detail, and in thirteen further patients with bone metastases, TMI applied to metastatic bone lesions was followed by relief of periosteal pain. In both index patients, follow-up Ga-68-PSMA PET-CT showed marked regression of the osseous lesions. Treatments were tolerated without device-related complications; in one patient the piezoelectric technique was not tolerated and was replaced by the electrohydraulic technique.
CONCLUSION: TMI treatment combines direct mechanotransduction with controlled cavitation, potentially disrupting tumor cells and microvasculature and inducing features of immunogenic cell death. In the patients reported here, palliative TMI treatment was associated with pain relief and radiographic tumor regression, including observations compatible with a possible immunological abscopal response. These observations derive from uncontrolled individual healing attempts under concomitant systemic therapy and require prospective confirmation.

Keywords:  Bone metastases ; Palliative pain management ; Tumor-destructive mechanical impulses ; Simulation-guided therapy ; Focused shock waves ; Immunological abscopal effect

DOI:  https://doi.org/10.33594/000000885
Pain Res Manag. 2026 ;2026(1): e7404872

Different Acupuncture Combined With Three-Step Analgesic Therapy in the Treatment of Bone Metastatic Cancer Pain: A Network Meta-Analysis Based on Randomized Controlled Trials.

Bofeng Zhao, Weiming Cao, Peijie Qin, Shiheng Wang.

   BACKGROUND: Cancer pain (CP) is predominantly caused by bone metastases, imposing a significant burden on both patients and society. The limitations of the three-step analgesic (TSA) therapy in managing CP have become increasingly evident. Although acupuncture demonstrates promising therapeutic effects for this condition, there is currently limited research comparing the efficacy of different acupuncture modalities.
RESULTS: A total of 20 studies were included, involving 1640 patients. The tumor types included lung cancer, prostate cancer, colorectal cancer, bile duct cancer, and breast cancer. A total of 9 acupuncture therapies were involved: acupoint embedding, auricular point pressing, electroacupuncture, ordinary acupuncture, bee therapy, fire needle therapy, moxibustion, acupoint injection, and acupoint application. The main outcome indicators were pain relief rate and NRS score, while the secondary outcome was the incidence of adverse reactions. The consistency test results showed no significant inconsistency among the comparison groups (p > 0.05), and a consistency model analysis was adopted. In terms of pain relief rate, electroacupuncture combined with auricular point pressing combined with the TSA therapy ranked the top three (SUCRA = 0.90), moxibustion combined with the TSA therapy ranked the top three (SUCRA = 0.84), and auricular point pressing combined with the TSA therapy ranked the top three (SUCRA = 0.65). In terms of reducing NRS scores, auricular point pressing combined with the TSA therapy ranked the top (SUCRA = 0.95), bee therapy combined with the TSA therapy ranked the top (SUCRA = 0.83), and acupuncture combined with acupoint injection combined with the TSA therapy ranked the top (SUCRA = 0.70). In terms of safety, the adverse reaction rate of fire needle therapy combined with the TSA therapy was the lowest (SUCRA = 0.98), electroacupuncture combined with auricular point pressing combined with the TSA therapy ranked the top (SUCRA = 0.81), and acupoint embedding combined with the TSA therapy ranked the top (SUCRA = 0.67). In terms of overall efficacy and safety, auricular point pressing combined with the TSA therapy performed the best in the benefit-risk assessment.
CONCLUSION: Acupuncture combined with the TSA therapy can effectively relieve CP in bone metastasis, with fewer adverse reactions. The current evidence indicates that auricular point pressing combined with the TSA therapy is the best treatment option in terms of comprehensive benefits. Due to the limited number of included studies, low quality of evidence, and potential bias risks, the conclusion still needs to be further verified by high-quality research.

Keywords:  TSA; acupuncture; bone metastatic cancer pain; network meta-analysis

DOI:  https://doi.org/10.1155/prm/7404872
Neurosurg Rev. 2026 Sep 01. pii: 545. [Epub ahead of print]49(1):

The role of stereotactic radiosurgery for prostate cancer spine metastasis - impact on hormone sensitivity and treatment outcomes: a systematic review of literature.

Aaditya Dravid, Suvan Sundaresh, David Wang, Philip Heesen, Vivek Sanker, Amirhossein Akhavan-Sigari, Maria Jose Cavagnaro, Harminder Singh, John Ratliff, Atman Desai.

  Spinal metastases are a common and morbid manifestation of advanced prostate cancer. Stereotactic body radiotherapy (SBRT), including single-fraction stereotactic radiosurgery (SRS), has emerged as a high-precision modality capable of delivering ablative doses with excellent local control. However, outcomes following spinal SBRT may differ according to hormonal sensitivity, particularly between hormone-sensitive prostate cancer (HSPC) and castration-resistant prostate cancer (CRPC). To systematically evaluate outcomes following stereotactic body radiotherapy for prostate cancer spinal metastases and assess differences between hormone-sensitive and castration-resistant disease. A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, Cochrane Library, and Embase databases were searched on 20/06/2025. Eligible studies included adult patients with spinal metastases from prostate adenocarcinoma treated with SBRT/SRS and reported outcomes stratified by hormonal status where available. Data extracted included local control (LC), overall survival (OS), progression to castration resistance, pain response, treatment-related toxicity, and radiation dose-fractionation parameters including biologically effective dose (BED₃). Study quality was assessed using the ROBINS-I tool. Five studies including 322 patients and 501 spinal lesions were included. Spinal SBRT achieved high local control, with 1-2-year LC typically exceeding 90%. In the two studies (approximately 174 patients) that directly compared disease states, local control and survival were numerically and statistically more favourable in HSPC patients. Because this contrast rests on only two non-randomised studies with differing systemic-therapy exposure, it should be regarded as hypothesis-generating.Overall survival similarly favored HSPC, with 1- to 3-year OS rates markedly higher than those observed in CRPC populations. Progression to castration resistance was described in a minority of the studies but suggested more favorable disease control in HSPC patients, who also achieved deeper post-treatment PSA nadirs and lower rates of biochemical relapse. Pain response was favorable overall, with approximately half of symptomatic patients experiencing complete or partial pain relief. Treatment-related toxicity was low overall, with vertebral compression fracture rates ranging from 4-10% and predominantly grade I-II adverse events. Dose-fractionation schedules varied widely, with BED₃ values ranging from approximately 70 to 191 Gy₃; higher BED₃ regimens were commonly associated with durable local control, though optimal dosing thresholds remain undefined. These calculations are presented to illustrate radiobiological heterogeneity across treatment regimens, but they do not permit conclusions regarding dose-response relationships or optimal biological dose thresholds. Available data suggest that SBRT provides effective local control and meaningful symptom relief for spinal metastases from prostate cancer, with acceptable toxicity. Available data are consistent with more favourable outcomes in hormone-sensitive disease; however, because direct HSPC-versus-CRPC comparisons were available in only two of five studies, with non-randomised systemic-therapy allocation, this association should be considered hypothesis-generating and requires prospective confirmation. While SBRT represents an effective metastasis-directed therapy in both settings, the current evidence base is limited and derived from small retrospective and early prospective studies, thus prospective studies are needed to clarify optimal dosing strategies, BED-based thresholds, and the role of SBRT in modifying disease progression and survival, particularly in CRPC.

Keywords:  Prostate cancer; SBRT; Spine metastases; Survival; Toxicity

DOI:  https://doi.org/10.1007/s10143-026-04464-x
Anticancer Res. 2026 Sep;46(9): 5181-5191

Efficacy and Safety of Stereotactic Body Radiation Therapy for Metastatic Bone Tumors in Clinical Practice.

Akira Setoguchi, Kazuhiko Hayashi, Jun Iijima, Moe Murakami, Hiroshi Ishikawa, Hitoshi Ono, Masataka Nakai, Yasutoshi Fumimoto, Nobuyuki Tamaki, Yuichi Akino, Masashi Yagi, Shotaro Tatekawa, Takero Hirata, Keisuke Tamari, Shinichi Shimizu, Satoaki Nakamura, Kazuhiko Ogawa.

   BACKGROUND/AIM: The development of radiation techniques has demonstrated that stereotactic body radiation therapy (SBRT) effectively achieves good local control and long-term pain palliation for metastatic bone tumors. This study evaluated the efficacy and safety of SBRT for metastatic bone tumors in clinical practice.
PATIENTS AND METHODS: Fifty-five patients with 64 metastatic bone tumors treated at the University of Osaka Hospital from July 2014 to March 2022 were retrospectively analyzed. Local failure (LF) rates were estimated using competing risk analysis, and overall survival (OS) rates using the Kaplan-Meier method. Pain response rates were assessed as complete response, partial response, and pain progression based on the patient's chief complaint at three months, six months, and the last follow-up. Treatment response was determined using the Spine Response Assessment in Neuro-Oncology criteria.
RESULTS: The most common primary site was the prostate (n=18), and the spine was the most prevalent radiation site (n=45). Dose prescription was performed at a planning target volume of D95%, with a median dose fraction of 35 Gy in five fractions. The median follow-up duration was 25.8 months (range=1.9-60.5 months), and the 2-year LF and OS rates were 3.4% and 72.4%, respectively. The pain response rate three months post-SBRT was 93.8%. Grade 2 and 3 toxicities occurred in 4.7% (three cases) and 1.6% (one case), respectively.
CONCLUSION: SBRT for metastatic bone tumors achieved low LF rates with low toxicity and favorable pain response and is an effective treatment option in clinical practice.

Keywords:  Stereotactic body radiation therapy; local failure; metastatic bone tumors; oligometastases; overall survival; pain response

DOI:  https://doi.org/10.21873/anticanres.18363