bims-rebome Biomed News
on Management of bone metastases
Issue of 2026–10–18
ten papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata
  1. Orthopaedic Management of Bone Metastases from Lung Cancer.
  2. Incremental Value of Radiation Dose for Prognostic Stratification Beyond Performance Status in Palliative Radiation Therapy for Bone Metastases.
  3. Cervical Spine Oncology: Perioperative Management and Complications.
  4. Stereotactic body radiotherapy versus conventional external beam radiotherapy for bone metastases: a meta-analysis.
  5. "Single-Centre Audit of Bone-Modifying Agents in Neuroendocrine Neoplasm Bone Metastases".
  6. Surgical Indications and Planning in Cervical Spine Oncology: A NOMS-Informed Framework for Metastatic and Primary Tumors of the Cervical Spine.
  7. Bone Radiopharmaceuticals: Evolution from Palliative Therapy to Targeted Precision Oncology and Theranostics.
  8. Prediction of Postoperative Ambulatory Function Using Nomogram in Patients with Metastatic Epidural Spinal Cord Compression.
  9. Stereotactic body radiation therapy in elderly patients with spinal metastases.
  10. Evaluation of Preoperative Factors Associated with Early Postoperative Neurological Outcome in the Treatment of Metastatic Spinal Tumors.
  1. Cancers (Basel). 2026 Oct 07. pii: 3228. [Epub ahead of print]18(19):
    Orthopaedic Management of Bone Metastases from Lung Cancer.
    Júlio Martins Lopes, Vânia Oliveira, Pedro Cardoso, Manuel Magalhães, Paula Fidalgo, António Araújo.
       BACKGROUND/OBJECTIVES: Bone metastases from lung cancer can cause pain, pathological fracture, spinal instability, metastatic spinal cord compression and loss of independence. Lung cancer-specific evidence for orthopaedically relevant local management remains fragmented. This review assessed outcomes across spinal, appendicular and pelvic skeletal disease, while explicitly examining the anatomical distribution and limitations of the evidence.
    METHODS: PubMed, Web of Science, Europe PMC and Scopus were searched for original studies published from January 2015 to December 2025. Eligible studies evaluated orthopaedic, surgical, minimally invasive or percutaneous skeletal interventions, including radiotherapy when combined with or directly compared with an orthopaedically relevant local strategy. Two reviewers independently screened studies, extracted data and completed the full Joanna Briggs Institute checklist applicable to each design. Findings were synthesised narratively, with evidence certainty assessed using GRADE.
    RESULTS: Thirty-three studies comprising 3585 participants with lung cancer were included; 26 were retrospective observational studies. Thirty studies predominantly evaluated axial disease, mainly spinal metastases, whereas only six included appendicular lesions; these categories were not mutually exclusive. Local interventions were associated with pain relief, maintenance or recovery of ambulation, neurological improvement and local symptom control in selected patients. Comparative survival findings were inconsistent and vulnerable to selection bias and confounding by indication; no causal survival benefit of surgery was established. Complication patterns differed by intervention type. Overall certainty was low to very low and was weakest for appendicular and pelvic disease.
    CONCLUSIONS: Orthopaedic management can be clinically important for preserving function and controlling mechanical or neurological complications, but the evidence is substantially stronger for spinal than for extraspinal disease. Treatment should remain multidisciplinary and individualised. The proposed decision frameworks are conceptual and guideline-informed rather than validated treatment algorithms.
    Keywords:  bone metastases; clinical decision-making; lung cancer; metastatic spinal cord compression; orthopaedic management; pathological fractures
    DOI:  https://doi.org/10.3390/cancers18193228
  2. Adv Radiat Oncol. 2026 Dec;11(12): 102170
    Incremental Value of Radiation Dose for Prognostic Stratification Beyond Performance Status in Palliative Radiation Therapy for Bone Metastases.
    Yui Watanabe, Takuya Tomoda, Akiko Iwata, Hirokazu Matsuno, Hiroto Hayakawa, Takeshi Nagata.
       Purpose: Although the individual prognostic value of performance status (PS) and prescribed dose for overall survival (OS) in palliative radiation therapy for bone metastases has been investigated, their combined prognostic significance has not been thoroughly explored. This study aimed to evaluate the combined prognostic value of PS and prescribed dose for OS in patients with bone metastases undergoing palliative radiation therapy.
    Methods and Materials: This study included 423 patients who underwent palliative radiation therapy for bone metastases between January 2013 and October 2024. The primary endpoint was OS, evaluated at fixed follow-up points of 1, 3, and 6 months, as well as 1, 2, and 3 years.
    Results: Univariate Cox regression analysis demonstrated that 1-year OS was significantly associated with poor PS (hazard ratio, 2.6 [95% CI, 2.2-3.1]; P < .001) and a lower prescribed dose (<39 Gy in a biologically effective dose with α/β = 10; hazard ratio, 3.9 [95% CI, 2.8-5.3]; P < .001), both of which remained independent predictors of worse OS in multivariate analysis (both P < .001). Comparison of the areas under the curves showed that adding prescribed dose to PS significantly improved the predictive accuracy of OS at 1 and 3 months (both P < .001), 6 months (P = .002), 1 year (P = .028), and 2 years (P = .032). However, the improvement was not statistically significant at 3 years (P = .086). Kaplan-Meier curve analysis with log-rank tests showed that combining PS and prescribed dose improved OS risk stratification (P < .001 for all follow-up periods), regardless of primary tumor risk or the number of distant metastases.
    Conclusions: Combining PS and prescribed dose enabled more refined risk stratification for predicting short- and long-term OS in patients with bone metastases undergoing palliative radiation therapy, regardless of primary tumor risk classification or the number of distant metastases. Moreover, adding prescribed dose to PS provided significant incremental predictive value for OS in this setting.
    DOI:  https://doi.org/10.1016/j.adro.2026.102170
  3. Clin Spine Surg. 2026 Oct 16.
    Cervical Spine Oncology: Perioperative Management and Complications.
    Hania Shahzad, Reginald Chinweze, Richard Price, Hai V Le, Wyatt Vander Voort, Safdar N Khan.
       STUDY DESIGN: Narrative review.
    OBJECTIVE: To synthesize contemporary evidence on perioperative complications in primary and metastatic cervical spine tumor surgery and to provide an evidence-informed framework for their prevention and management.
    SUMMARY OF BACKGROUND DATA: Cervical spine tumor surgery converges dense neurovascular and aerodigestive anatomy with a medically fragile, frequently irradiated patient population. Although cervical metastases represent only about 8-20% of spinal metastatic disease, their mismanagement carries disproportionately severe consequences, ranging from disabling pain to high-level paralysis and death. Cervical-specific risk-stratification tools are lacking, and most available evidence is extrapolated from degenerative anterior cervical cohorts.
    METHODS: This is a narrative review of perioperative complications in cervical spine oncology. PubMed/MEDLINE and Google Scholar were searched for English-language articles published through May 2026, prioritizing literature from the past 5 years while including seminal earlier references where foundational, using combinations of the terms "cervical spine," "spinal metastasis," "spinal tumor," "perioperative complications," "airway," "vertebral artery," "wound," "dysphagia," "venous thromboembolism," and "hardware failure." Reference lists of included articles were hand-searched for additional sources. Studies were selected by author consensus for relevance to the complication domains discussed; formal risk-of-bias assessment and quantitative pooling were not performed, consistent with a narrative design. Because oncology-specific evidence is limited, data derived from degenerative cervical cohorts are identified as such throughout.
    RESULTS: Major complication domains include airway compromise (highest with multilevel corpectomy, combined approaches, and cervicothoracic constructs), vascular and neurologic injury, CSF leak, wound failure and infection in irradiated fields, hardware failure, venous thromboembolism, and dysphagia.
    CONCLUSIONS: Outcomes depend on preoperative risk stratification, multidisciplinary coordination, and individualized postoperative care rather than any single intraoperative maneuver. Because the evidence base remains largely Level III-IV without validated cervical oncology-specific tools, described practices should be regarded as reasonable, evidence-informed considerations rather than standards of care.
    Keywords:  airway management; cervical spine; dysphagia; hardware failure; perioperative complications; spinal metastases; spinal oncology
    DOI:  https://doi.org/10.1097/BSD.0000000000002189
  4. Clin Exp Metastasis. 2026 Oct 12. pii: 53. [Epub ahead of print]43(5):
    Stereotactic body radiotherapy versus conventional external beam radiotherapy for bone metastases: a meta-analysis.
    Marc Boutros, Jean-Pierre Saad, Guy Awad, Kamal Bou Hamdan, William Eward.
      Stereotactic body radiotherapy (SBRT) and conventional external beam radiotherapy (cEBRT) are widely used treatment options for the management of painful bone metastases. Randomized phase III trials have provided direct comparative evidence for SBRT and cEBRT; however, their results vary according to treatment regimen and clinical endpoint, supporting a broader quantitative synthesis of pain response, local control, retreatment, and safety outcomes. A systematic search was conducted in PubMed, Scopus, the Cochrane Library, and Google Scholar from database inception through January 2026. Comparative clinical studies evaluating SBRT versus cEBRT for bone metastases were included. Outcomes assessed encompassed pain-related measures (change in Visual Analog Scale scores at 3 and 6 months; complete, partial, stable, and progressive pain response), opioid consumption at 3 and 6 months, radiologic local progression or treatment failure at 8 months, re-irradiation at 12 months, skeletal-related events (vertebral and non-vertebral compression fractures), spinal cord compression, treatment-related toxicity, and overall survival at 1 year. Pooled analyses were performed using random-effects models. Early pain reduction at 3 months, partial and stable pain response, and opioid consumption at 3 and 6 months were comparable between SBRT and cEBRT (all p > 0.05). However, SBRT demonstrated superior mid-term outcomes, with a significantly higher complete pain response at 6 months (RR = 1.43; p = 0.001) and a significantly lower rate of progressive pain response at 6 months (RR = 0.61; p = 0.03). SBRT was also associated with markedly improved local disease control, reflected by lower rates of radiologic local progression or treatment failure at 8 months (RR = 0.36; p < 0.001) and a substantially reduced need for re-irradiation at 12 months (RR = 0.13; p < 0.001). Rates of vertebral and non-vertebral compression fractures, spinal cord compression, treatment-related toxicity, and overall survival at 1 year did not differ significantly between treatment modalities. This meta-analysis demonstrates that both SBRT and cEBRT are safe and effective treatment options for patients with painful bone metastases. While early pain palliation and safety outcomes are comparable, SBRT provides superior durability of pain control, reduced pain progression, improved local tumor control, and a markedly lower need for re-irradiation. SBRT may be particularly advantageous for patients with longer expected survival, oligometastatic disease, or lesions at higher risk of progression, whereas cEBRT remains an effective and accessible option for rapid symptom palliation in patients with limited prognosis.
    Keywords:  Bone metastases; Conventional external beam radiotherapy; Local control; Meta-analysis; Pain response; Re-irradiation; Stereotactic body radiotherapy
    DOI:  https://doi.org/10.1007/s10585-026-10435-9
  5. Endocr Connect. 2026 Oct 13. pii: EC-26-0252. [Epub ahead of print]
    "Single-Centre Audit of Bone-Modifying Agents in Neuroendocrine Neoplasm Bone Metastases".
    Wessam Osman, Preetha Aravind, Hemanth Prabhudev, Jeannie Todd, Ramona Nistor, Antonio D'Alessio, Rohini Sharma, Tami Grunewald, Florian Wernig.
      Bone metastases in neuroendocrine neoplasms are uncommon but cause significant morbidity. A recent Italian survey of 320 patients with neuroendocrine neoplasms and bone metastases reported skeletal-related events in 23% and bone-targeted agent use in 31%, highlighting limited evidence for bone-modifying agents. We identified adults with confirmed or clinically suspected neuroendocrine bone involvement who received a bone-modifying agent at a UK tertiary centre (January 2019-September 2024), using institutional prescribing records. Demographic, tumour, treatment, and toxicity data were extracted from records. Twenty-two patients received treatment (denosumab 17 [77%], zoledronic acid 5 [23%]). Most (91%) had grade 1-2 tumours; 64% had gastro-entero-pancreatic primaries. Bone metastases were synchronous in 46% and widespread (more than three lesions) in 73%. At diagnosis, 22% were symptomatic; during follow-up, 78% developed pain, high blood calcium, or a skeletal-related event. Skeletal-related events, a composite of pathological fracture, spinal cord compression, radiotherapy to bone, or orthopaedic surgery, occurred in 41% (radiotherapy alone in 36%); pain-relieving medication was used universally. Treatment was mainly given every 12 weeks (median six doses). Low blood calcium occurred in 9% and osteonecrosis of the jaw in 5%; dental assessment before therapy was recorded in only 9%. These figures are broadly consistent with the Italian survey cited above. Treatment use was heterogeneous, reflecting a lack of disease-specific guidelines, and toxicity was comparable to other solid tumours and generally manageable. Our findings highlight the need for prospective studies and structured registries to clarify treatment use, dosing, and impact on quality of life and prognosis.
    Keywords:  bone metastases; bone-modifying agents; denosumab; neuroendocrine neoplasms; skeletal-related events; zoledronic acid
    DOI:  https://doi.org/10.1530/EC-26-0252
  6. Clin Spine Surg. 2026 Oct 16.
    Surgical Indications and Planning in Cervical Spine Oncology: A NOMS-Informed Framework for Metastatic and Primary Tumors of the Cervical Spine.
    Graham M Winston, David Sykes, William C Newman, Mark Bilsky.
       STUDY DESIGN: Narrative review of contemporary literature alongside institutional experience applying the NOMS framework to cervical spine tumors.
    OBJECTIVE: To supplement the NOMS framework with cervical spine-specific considerations: summary of background data.The NOMS framework provides a widely applicable approach to spinal oncology based on neurological, oncologic, mechanical, and systemic factors.
    METHODS: Contemporary literature and published institutional experience addressing cervical spine tumors were reviewed.
    RESULTS: Cervical spine tumors require region-specific modification of conventional NOMS decision-making. Mechanical considerations are particularly important at the occipitocervical and cervicothoracic junctions, where tumor-related or iatrogenic instability may necessitate extended constructs and careful fixation strategies.Systemic factors, including frailty, malnutrition, prior radiation, active therapy, and prognosis, remain critical determinants of surgical candidacy. Complex cases may require multidisciplinary planning.
    CONCLUSIONS: NOMS remains a useful foundation for cervical spine oncology but should be supplemented by region-specific anatomic and biomechanical considerations.Treatment should be individualized according to neurological compromise, tumor biology, mechanical stability, systemic disease, and surgical morbidity. As radiation and systemic therapies advance, surgery should primarily address decompression, stabilization, and tissue diagnosis rather than serve as a stand-alone modality for local control.
    Keywords:  cervical spine; neurosurgery; neurosurgical oncology; radiation oncology; spinal oncology; spine surgery
    DOI:  https://doi.org/10.1097/BSD.0000000000002192
  7. Biology (Basel). 2026 Oct 08. pii: 1784. [Epub ahead of print]15(19):
    Bone Radiopharmaceuticals: Evolution from Palliative Therapy to Targeted Precision Oncology and Theranostics.
    Andras Polyak, Christiane Matuschek.
      Bone radiopharmaceuticals have evolved from early palliative agents into integral components of targeted precision oncology and theranostics. This review comprehensively traces the historical trajectory, pathophysiological mechanisms, and clinical applications of bone-directed nuclear medicine. We contrast primary bone malignancies-which directly produce malignant osteoid matrix-with metastatic bone disease, which colonizes the endosteal niche via the RANK/RANKL/OPG axis and the metastatic vicious cycle. The molecular mechanisms governing skeletal radioisotope localization are systematically detailed, encompassing calcium mimetics (223Ra), inorganic phosphate integration (32P), hydroxyapatite chemisorption (99mTc-labeled diphosphonates), isomorphous surface exchange ([18F]NaF), and direct biomarker targeting. Furthermore, we highlight the therapeutic transition from medium-range beta-emitters to high-linear energy transfer (LET) targeted alpha therapy (225Ac), nanometer-scale Auger electron emitters, and cell-directed theranostic vectors. By unifying radiopharmaceutical chemistry, microdosimetry, and emerging artificial intelligence-driven personalized dosimetry, this review provides a strategic roadmap for advancing precision bone endoradiotherapy.
    Keywords:  Auger electrons; alpha emitters; bisphosphonates; bone metastases; bone radiopharmaceuticals; bone tumor; skeletal scintigraphy; theranostics
    DOI:  https://doi.org/10.3390/biology15191784
  8. J Clin Med. 2026 Sep 25. pii: 7459. [Epub ahead of print]15(19):
    Prediction of Postoperative Ambulatory Function Using Nomogram in Patients with Metastatic Epidural Spinal Cord Compression.
    Ibrahim S Alayed, Sehan Park, Dong-Ho Lee, Chang Ju Hwang, Sung Tan Cho, Jae Hwan Cho.
      Background/Objectives: This study was conducted to develop and internally validate a nomogram that predicts postoperative ambulatory function in patients with metastatic epidural spinal cord compression (MESCC) undergoing decompressive surgery. Methods: Of 352 patients who underwent surgery for metastatic spinal cancer at a single tertiary center between 2014 and 2021, 97 with MESCC (Bilsky grade 2-3) and preoperative neurological deficits (ASIA grade D or worse) were included in this retrospective study. Binary logistic regression was used to identify candidate predictors of 3-month postoperative ambulatory status in the full cohort (p < 0.10 in univariable analysis), which were then entered into a multivariable logistic regression model and incorporated into a nomogram using the rms package in R. Model discrimination and calibration were internally validated using Harrell's bootstrap optimism-correction method with 1000 resamples. Results: Postoperative ambulation was regained in 24 patients (24.7%). Four variables met the prespecified threshold (p < 0.10) for inclusion in the nomogram: preoperative motor grade (OR 2.48; 95% CI 1.41-4.34; p = 0.002), symptom onset-to-operation interval (OR 0.81; 95% CI 0.62-1.04; p = 0.098), preoperative KPS (OR 1.04; 95% CI 1.00-1.07; p = 0.070), and age (OR 0.97; 95% CI 0.93-1.01; p = 0.087); in the multivariable model, only preoperative motor grade and symptom onset-to-operation interval were independently associated with ambulatory recovery (p < 0.05). The nomogram achieved an apparent AUC of 0.827 (optimism-corrected, 0.800) and acceptable-to-good calibration (optimism-corrected calibration slope, 0.848; intercept, -0.088). At the Youden-optimal threshold, apparent (optimism-corrected) sensitivity, specificity, and F1 score were 79.2% (74.5%), 78.1% (76.7%), and 64.4% (60.6%), respectively. Conclusions: The nomogram demonstrated acceptable discrimination and good calibration for predicting postoperative ambulation in patients with MESCC. This tool may support individualized surgical decision-making and patient counseling. External validation is required before routine clinical use.
    Keywords:  Karnofsky performance score; decompressive surgery; metastatic epidural spinal cord compression; neurological recovery; nomogram; postoperative ambulation; predictive model; spinal metastasis
    DOI:  https://doi.org/10.3390/jcm15197459
  9. J Neurooncol. 2026 Oct 16. pii: 22. [Epub ahead of print]180(2):
    Stereotactic body radiation therapy in elderly patients with spinal metastases.
    Brock J Gjesdal, Samuel Adida, Suchet Taori, Andrew H Zureick, Serah Choi, John C Flickinger, Pascal O Zinn, James C Bayley, Peter C Gerszten, Roberta K Sefcik.
       PURPOSE: Elderly patients with spinal metastases are often considered poor candidates for aggressive local therapy, due in part to medical comorbidity and limited evidence to guide treatment selection. This study evaluated outcomes following spine stereotactic body radiation therapy (SBRT) in this patient population and examined predictors of local failure (LF) and vertebral compression fracture (VCF).
    METHODS: A prospectively maintained database of consecutive patients aged ≥ 70 years with available imaging who underwent spine SBRT at a quaternary referral center from 2002 to 2024 was analyzed. The median single-fraction dose was 16 Gy (range: 12-18 Gy), and multi-fraction regimens ranged from 18 to 35 Gy in 2-5 fractions.
    RESULTS: Of 208 metastases in 161 patients (median age: 75 years, range: 70-94 years), 72% had prior conventional radiotherapy and 76% received a single fraction. The 6-, 12-, 24-, and 36-month cumulative incidence rates were 6%, 9%, 9%, and 10% for LF and 4%, 7%, 8%, and 9% for VCF (median follow-up: 9 months, range: 1-132 months). Gross tumor volume > 37 cc (subdistribution hazard ratio [sHR]: 6.27, 95% confidence interval [CI]: 1.48-26.63, P = 0.013) and Spinal Instability Neoplastic Score (SINS, per-point sHR: 1.23, 95% CI: 1.07-1.42, P = 0.005) were independently associated with LF; only SINS was independently associated with VCF (per-point sHR: 1.19, 95% CI: 1.06-1.34, P = 0.003), and 11 of 17 VCFs required cement augmentation or surgery. Age was associated with overall survival (hazard ratio: 1.05 per year, 95% CI: 1.01-1.09, P = 0.018); no statistically significant association was detected with LF or VCF when age was analyzed continuously, at thresholds of 75 or 80 years, or by exploratory maximally selected rank statistical analysis. Complete or partial pain response followed 61 of 148 evaluable treatments (41%) among 186 symptomatic metastases, and 18% of patients had grade 1-2 radiation toxicity.
    CONCLUSION: Spine SBRT, predominantly single-fraction reirradiation, was associated with low rates of LF and VCF; chronologic age alone should not preclude its use in appropriately selected elderly patients.
    Keywords:  Elderly; SBRT; SRS; Spine oncology; Stereotactic body radiation therapy; Stereotactic radiosurgery
    DOI:  https://doi.org/10.1007/s11060-026-05838-3
  10. Indian J Orthop. 2026 Oct;60(10): 2690-2697
    Evaluation of Preoperative Factors Associated with Early Postoperative Neurological Outcome in the Treatment of Metastatic Spinal Tumors.
    Koji Matsumoto, Hirokatsu Sawada, Sosuke Saito, Tomohiro Furuya, Yuya Miyanaga, Kazuyoshi Nakanishi.
       Purpose: To investigate the preoperative factors that affect early postoperative neurological outcome of metastatic spinal tumors in order to determine a new basis for surgical indication.
    Methods: Eighty-seven patients with metastatic spinal tumors were included. Neurological status was assessed using the American Spinal Injury Association (ASIA) grade at 1 month postoperatively, with an additional evaluation at 3 months. Patients with preoperative ASIA grades B or C whose postoperative ASIA grade remained unchanged or worsened, and those with preoperative ASIA grades D or E whose postoperative grade worsened, were classified as having a poor neurological outcome. Patients whose postoperative ASIA grade improved were classified as the improved group. Preoperative clinical and radiological factors, including ASIA grade and spinal cord compression site, were analyzed using univariate and multivariate logistic regression analyses.
    Results: Multivariate analysis identified preoperative ASIA grade B or C and circumferential spinal cord compression (anterior + posterior) as independent risk factors for poor neurological outcome at 1 month. In contrast, posterior-only spinal cord compression was an independent predictor of neurological improvement. Among patients with preoperative ASIA grades B or C, 11 of 12 patients with anterior + posterior compression experienced poor neurological outcomes, whereas 6 of 7 patients with posterior compression showed neurological improvement.
    Conclusions: The spinal cord compression site was a neurological prognostic factor for early postoperative neurological outcome. Even in cases with an ASIA grade of B or C, neurological improvement in the early postoperative period was anticipated if the compression site was posterior-only.
    Keywords:  ASIA grade; Metastatic spinal tumor; Neurological prognosis; Preoperative factor
    DOI:  https://doi.org/10.1007/s43465-026-01754-w
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