bims-rebome 2025-10-05 papers

Future Sci OA. 2025 Dec;11(1): 2565097

Rehabilitation intervention to prevent adverse events related to ADT in patients with metastatic prostate cancer.

Stefania Di Girolamo, Barbara Bressi, Cristina Masini, Stefania Fugazzaro, Stefania Costi, Monica Messori, Alessia Pecorari, Maria Beatrice Galavotti, Carlotta Sola, Claudia Ferrara, Amelia Altavilla, Giamaica Ciardiello, Luca Braglia, Matteo Augugliaro, Carmine Pinto.

In patients with prostate cancer (PCa), androgen deprivation therapy (ADT) is associated with multiple side effects, including increased fat mass (FM), loss of muscle mass and strength, osteoporosis, risk of falls, disability, fatigue, and a decline in quality of life (QoL). Multicomponent exercise programs have been shown to mitigate several of these adverse events.
Preliminary evidence suggests that exercise can be safely implemented in patients with metastatic PCa and that physical inactivity should be avoided, even in advanced stages. However, studies involving this fragile population remain limited.
This single-arm interventional study aims to evaluate the feasibility and safety of an exercise-based rehabilitation program in hormone-sensitive patients undergoing ADT, alone or combined with other therapies.

Keywords: adverse events; androgen-deprivation therapy; exercise; feasibility; metastatic prostate cancer; rehabilitation

DOI: https://doi.org/10.1080/20565623.2025.2565097

Ann Med. 2025 Dec;57(1): 2568117

Initial management and disposition of metastatic spinal cord compression in the emergency department: a review of the literature.

Emad Singer, Ahmed Elsayem, Tracy Nassif, Christopher Rodriguez, Marianne Zoghbi, Jim Dagher, Nicole Yammine, Mona Kamal, Maria T Cruz Carreras, Trien Vu, Aiham Qdaisat, Sai-Ching J Yeung, Patrick Chaftari.

BACKGROUND: Metastatic spinal cord compression (MSCC) is a serious medical emergency that can complicate the course of various malignancies, including prostate, breast, and lung cancers. Appropriate evaluation and effective management of MSCC early in the emergency department are necessary to minimize neurologic deterioration and optimize the trajectory of patient recovery.
METHODS: This literature review examines and summarizes current evidence surrounding the emergency department approach for timely recognition, initial evaluation, and management of MSCC.
RESULTS: A comprehensive clinical history, nerve root or spinal cord clinical examination, and urgent imaging procedures are fundamental for early diagnosis and initial management. The urgency of intervention depends on the rate of onset of motor deficits, which can progress during work-up. Patients should be stratified into subgroups: those requiring immediate surgery, those who can be treated with radiotherapy, and those who may be discharged for outpatient care. Some patients can be observed for 24 h to adjust the medical and/or surgical treatment. In most cases, systemic steroid administration with dexamethasone should be started immediately upon diagnosis, followed by a tapering course of oral dexamethasone. Selected patients should undergo surgical decompression with or without stabilization. A multidisciplinary approach involving both spinal surgeons and radiation oncologists is essential for diagnosis and stratification.
CONCLUSION: For patients with MSCC, early and effective evaluation and intervention in the emergency department, through a coordinated multidisciplinary effort, are vital to optimizing patient outcomes.

Keywords: MSCC; Spinal cord compression; cancer; diagnosis; emergency; evaluation; management; metastatic; oncology; steroid

DOI: https://doi.org/10.1080/07853890.2025.2568117

Eur J Orthop Surg Traumatol. 2025 Sep 27. 35(1): 408

Complication and revision risks of surgical treatment for proximal humerus metastases: a systematic review.

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

PURPOSE: Surgical treatments for proximal humerus metastasis include modular prosthesis, intramedullary nailing, plate fixation, and hemiarthroplasty. However, it is controversial which surgical treatment could offer less complications and implant failure. The purpose of our study was to report the risk of complications, reoperations and revisions in patients with proximal humerus metastasis treated with modular prosthesis, intramedullary nailing, plate fixation, or hemiarthroplasty.
METHODS: We performed research in the PubMed and Scopus libraries, obtaining 2247 studies. We analyzed studies reporting the risk of complications, reoperations and removal of the implant in patients with proximal humerus metastasis treated with intramedullary nailing, plate fixation, hemiarthroplasty, or megaprosthesis.
RESULTS: We included 11 studies (357 patients) reporting patients treated with modular prosthesis (n = 181), intramedullary nailing (n = 101), plate fixation (n = 51) and hemiarthroplasty (n = 24). The risk of complications in patients with proximal humerus metastasis treated with modular prosthesis was 0-40%, with intramedullary nailing was 0-39%, with plate fixation was 0-67% and with hemiarthroplasty was 8%. The risk of reoperation in patients treated with modular prosthesis was between 0 and 20%, with intramedullary nailing was 0-3%, and with plate fixation was 0-33% and no patient treated with hemiarthroplasty had a reoperation. The risk of removal of the implant in patients treated with modular prosthesis and plate fixation was 0-20% and 0-33%, respectively. No patients treated with intramedullary nailing and hemiarthroplasty had a removal of the implant.
CONCLUSION: Modular prosthesis, intramedullary nailing, plate fixation and hemiarthroplasty seem to have similar risk of complications, reoperation and removal of the implant. Surgeons should consider the indications of each treatment option, taking into account other factors such as the location and size of the lesion, the quality of the cortical bone and the patient's life expectancy.

Keywords: Complication; Hemiarthroplasty; Intramedullary nailing; Modular prosthesis; Plate fixation; Proximal humerus metastasis; Reoperation; Revision; Surgical treatment

DOI: https://doi.org/10.1007/s00590-025-04527-7

BMJ Support Palliat Care. 2025 Oct 01. pii: spcare-2025-005680. [Epub ahead of print]

Glucocorticoids for pain flare prophylaxis after palliative radiotherapy for bone metastases: a systematic review and meta-analysis of randomised controlled trials.

Musa Salar, Hashim Salar, Sayyed Muhammad Fariz Ali, Alinah Qureshi, M Abdullah Jamil, Saniya Waseem, Hamzah Jehanzeb, Omar Mahmud, Asma Saleem, Muhammad Atif Waqar.

INTRODUCTION: Bone metastases (BMs) are a major cause of cancer-related pain. Palliative radiotherapy is effective for controlling these symptoms, but up to 40% of patients experience transient exacerbations of bone pain despite this. Glucocorticoids have been investigated for pain flare (PF) prophylaxis, but randomised controlled trials (RCTs) have yielded mixed results. The goal of this systematic review and meta-analysis was to analyse the pooled efficacy of glucocorticoids for PF prophylaxis after palliative radiotherapy to BMs.
METHODS: The PubMed, EMBASE and Cochrane CENTRAL databases were systematically searched from inception until August 2024. RCTs that compared PF incidence after radiotherapy to BMs in patients who received prophylaxis with glucocorticoids versus placebo were included. Meta-analyses were conducted using a Mantel-Haenszel random effects model. Risk-of-bias was assessed using the Cochrane Risk of Bias 2 tool.
RESULTS: We included four RCTs with a total of 765 patients. Three trials compared dexamethasone with placebo, while one trial compared methylprednisolone with placebo. Pooled analysis showed significantly reduced PF incidence after glucocorticoid prophylaxis (risk ratio: 0.59 (95% CI: 0.35 to 0.98), risk difference=-0.13 (95% CI: -0.24 to -0.02)). Study quality assessment indicated that two studies had a low risk of bias, while the other two had moderate and high risk, respectively.
CONCLUSION: Current randomised evidence supports the efficacy of glucocorticoid prophylaxis for the prevention of PFs in patients with BMs after the receipt of palliative radiation. Clinicians may consider this intervention to improve patient quality of life and symptom control.

Keywords: Pain; Palliative Care; Quality of life

DOI: https://doi.org/10.1136/spcare-2025-005680