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Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression-A New Integrative Flowchart for Patient Management.

Metastatic spine disease (MSD) and metastatic spinal cord compression (MSCC) are major causes of permanent neurological damage and long-term disability for cancer patients. The development of MSD is pathophysiologically framed by a cooperative interaction between general mechanisms of bone growth and specific mechanisms of spinal metastases (SM) expansion. SM most commonly affects the thoracic spine, even though multiple segments may be affected concomitantly. The great majority of SM are extradural, while intradural-extramedullary and intramedullary metastases are less frequently seen. The ma

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… Labels: RT—radiotherapy; EF—external Fixation; MESCC—metastatic epidural spinal cord compression; VP—vertebroplasty. … Labels: cEBRT—conventional external beam radiation therapy; MESCC—metastatic epidural spinal cord compression; SBRT—stereotactic body radiation Therapy; RT—radiotherapy; VP—vertebroplasty. 5. …

Chemotherapy May Obviate Prophylactic Femoral Nail Surgery for Multiple Myeloma Patients With High Mirels' Score Lesions and Impending Pathological Hip Fracture.

Bone involvement presents in >80% of patients with multiple myeloma. This causes lytic lesions for which prophylactic surgery is indicated to prevent pathological fractures if the lesion is graded ≥9/12 on Mirels' score. Although successful, these surgeries have risks and extended recovery periods. We present a case indicating myeloma chemotherapy may obviate prophylactic femoral nailing for high Mirels' score lesions in the femoral head with impending pathological hip fracture. A 72-year-old woman presented in December 2017 with back pain. A plain X-ray indicated degenerative anterolisthesis

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… Prophylactic orthopaedic surgery e.g. vertebroplasty, kyphoplasty and stabilisation for spinal lesions and nailing for long bone stabilisation [ 2 ], is indicated to prevent pathological fractures if the lesion is graded ≥9/12 on Mirels’ score [ 3 ]. …

The Neuro-Bone Axis in Metastatic Progression: Innervation, Neuro-Immune-Osteoclast Crosstalk, and Therapeutic Opportunities.

Bone metastases represent a major cause of morbidity in advanced cancers, yet the neural regulation of metastatic growth within bone remains largely unexplored. The skeletal system is richly innervated by sensory and sympathetic nerve fibers that influence bone remodeling, hematopoiesis, and immune surveillance. Emerging evidence suggests that disseminated tumor cells exploit these neural circuits to create a growth-permissive microenvironment. Tumor-secreted neurotrophic factors can induce nerve sprouting, while sympathetic activation via β-adrenergic receptors promotes osteoclastogenesis, im

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… These are now conventional interventional oncology modalities in the multidisciplinary management of bone metastases, and are frequently used in conjunction with vertebroplasty, surgical interventions, or radiotherapy [ 172 , 173 ]. … Current radiotherapy guidelines clearly state that vertebroplasty, cryoablation, and radiofrequency ablation do not replace radiotherapy, highlighting their function as local adjuncts rather than independent neuromodulatory treatments [ 172 ]. 6.5. …

The Danish National Multiple Myeloma Registry.

AimThe Danish National Multiple Myeloma Registry (DMMR) is a population-based clinical quality database established in January 2005. The primary aim of the database is to ensure that diagnosis and treatment of plasma cell dyscrasia are of uniform quality throughout the country. Another aim is to support research. Patients are registered with their unique Danish personal identification number, and the combined use of DMMR, other Danish National registries, and the Danish National Cancer Biobank offers a unique platform for population-based translational research.Study populationAll newly diagno

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… The new treatment options are expensive, and there is an increasing demand for documentation of the impact of antineoplastic treatment and supportive care, such as bisphosphonates, vertebroplasty, and erythropoietin. …

Management of Multiple Myeloma: A Review for General Practitioners in Oncology.

Multiple myeloma (MM) is a malignant clonal plasma cell disorder in the bone marrow and is the second-most common hematologic malignancy in adults. Although patients with MM have a moderate life expectancy, it remains a heterogeneous disease that often requires multiple lines of chemotherapy for durable control and long-term survival. This review outlines current management strategies for both transplant-eligible and transplant-ineligible patients as well as for relapsed and refractory disease. Advances in drug therapies have widened management options and improved survival. In this paper, we

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… Complication | Disease Factors | Treatment Factors | Patient Factors | Supportive Management Bone disease | Lytic lesions | Dysregulation of normal bone metabolism Osteoclastic activity | | | Pain management Steroid Radiation Kyphoplasty Vertebroplasty Orthopedic referral Hypercalcemia | Dysregulation … When lytic lesions are detected, management considerations include localized radiation or vertebroplasty for symptom control, surgical intervention for impending fractures, and bone protectors such as bisphosphonates to prevent further progression of bone disease [ 45 ]. …

Multiple myeloma in the very elderly patient: challenges and solutions.

Diagnosis and management of myeloma in the very elderly patient is challenging. Treatment options have vastly improved for elderly myeloma patients but still require the clinician to personalize therapy. In this paper, we offer evidence-based, pragmatic advice on how to overcome six of the main challenges likely to arise: 1) diagnosis of myeloma in this age group, 2) assessment of the need for treatment, and the fitness for combination chemotherapy, 3) provision of the best quality of supportive care, 4) choice of combination chemotherapy in those fit enough for it, 5) treatment of relapsed my

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… ; range 66–94 years) demonstrates that these high risk cytogenetic features predict poor outcomes regardless of age. 18 There should be a low threshold for magnetic resonance imaging (MRI) of the whole spine in proven cases of myeloma with back pain to help guide areas suitable for radiotherapy or vertebroplasty … Low-dose radiotherapy may be effective in the treatment of isolated painful bony lesions; typically, only a single dose (8 Gy) is required for adequate control. 29 Kyphoplasty or vertebroplasty may help when vertebral compression fractures results in pain unresponsive to analgesia or to stabilize vertebrae …

SEOM Clinical Guideline for bone metastases from solid tumours (2016).

Bone metastases are common in many advanced solid tumours, being breast, prostate, thyroid, lung, and renal cancer the most prevalent. Bone metastases can produce skeletal-related events (SREs), defined as pathological fracture, spinal cord compression, need of bone irradiation or need of bone surgery, and hypercalcaemia. Patients with bone metastases experience pain, functional impairment and have a negative impact on their quality of life. Several imaging techniques are available for diagnosis of this disease. Bone-targeted therapies include zoledronic acid, a potent biphosfonate, and denosu

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… Vertebroplasty and Kyphoplasty are reserved for patients with symptomatic vertebral body fractures without epidural disease or retropulsion of bone fragments into the spinal cord. … Kyphoplasty and vertebroplasty may be useful for the treatment of lytic osteoclastic spine metastases or in cases of spinal instability, where surgery is not feasible or indicated; they do not obviate the need for external beam RT. …

Frailty-adjusted therapy in Transplant Non-Eligible patients with newly diagnosed Multiple Myeloma (FiTNEss (UK-MRA Myeloma XIV Trial)): a study protocol for a randomised phase III trial.

INTRODUCTION: Multiple myeloma is a bone marrow cancer, which predominantly affects older people. The incidence is increasing in an ageing population.Over the last 10 years, patient outcomes have improved. However, this is less apparent in older, less fit patients, who are ineligible for stem cell transplant. Research is required in this patient group, taking into account frailty and aiming to improve: treatment tolerability, clinical outcomes and quality of life. METHODS AND ANALYSIS: Frailty-adjusted therapy in Transplant Non-Eligible patients with newly diagnosed Multiple Myeloma is a nati

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… This would include surgical intervention for relief of cord compression but does not include vertebroplasty or kyphoplasty. … This does not include vertebroplasty or kyphoplasty. Systemic treatment, within 14 days before the first dose of ixazomib with strong CYP3A inducers (eg, rifampicin, rifabutin, carbamazepine, phenytoin, phenobarbital), or use of St. John’s wort. …

Текущее качество жизненных вопросников не имеет значения для оценки проблем QOL у многих пациентов миэломы в эпоху современной терапии: результаты обследования, проведенного с пациентами миэломы и специалистами в области здравоохранения миеломы.

Поскольку многие пациенты миеломы (ММ) живут дольше, поддержание качества жизни (КОЛ) стало важной целью лечения. В то же время широко используемые вопросники по общему качеству жизни (QOLQs) были разработаны по сравнению с 20 Много лет назад. В этом обследовании 224 Пациенты ММ и 48 К специалистам в области здравоохранения (ХЦП) была обращена просьба оценить актуальность и важность предметов КОЛ из 9 аттестованные, часто используемые MM QOLQs. Результаты этого обследования выявили значительные расхождения в восприятии пациентами из числа ММ и ХЦП важных и актуальных вопросов КОЛ. Несмотря на

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… Spinal bracing, kyphoplasty and vertebroplasty can be considered for those with painful vertebral fractures but more studies are needed as data regarding clinical outcomes and QOL on patients with spinal interventions is scarce. …

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Clinical efficacy of Teriparatide combining Zhuanggu Zhitong capsules in the treatment of osteoporosis.

OBJECTIVE: To investigate the clinical efficacy of Teriparatide(TPTD) combining Zhuanggu Zhitong Capsules(ZZC) in the treatment of primary osteoporosis. METHODOLOGY: This single-center, retrospective cohort study consecutively enrolled eighty patients with primary osteoporosis who received treatment from August 2020 to August 2022. Patients were divided into two groups based on the treatment they received: the control group (n=40) and the treatment group (n=40). Both therapies continued for six months. Bone density, bone metabolism indicators, Visual Analogue Scale (VAS) score, Oswestry Disab

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… Comparison of different approaches of percutaneous vertebroplasty in the treatment of osteoporotic spinal compression fractures and analysis of influencing factors of re-fracture. Pak J Med Sci. 2023;39(1):144–149. doi: 10.12669/pjms.39.1.7069. doi:10.12669/pjms.39.1.7069. 3. …

Outcomes of Balloon Kyphoplasty for Vertebral Compression Fractures in Patients with Diffuse Idiopathic Skeletal Hyperostosis at the Distal End or Adjacent Vertebra of the Fused Segments.

Study designA retrospective cohort study.PurposeTo investigate the outcomes of balloon kyphoplasty (BKP) for vertebral compression fractures (VCFs) at the distal end or adjacent vertebra of the fused segments in patients with diffuse idiopathic skeletal hyperostosis (DISH).Overview of literatureVertebral fractures in the midportion of the fused segments in patients with DISH are generally unstable; thus, immobilization is recommended. However, VCFs classified as type A in the AO classification are observed at the distal end and adjacent vertebra of the fused segments, and treatment strategies

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… Analysis of risk factors for new vertebral fracture after percutaneous vertebroplasty. Global Spine J. 2018;8:446–52. doi: 10.1177/2192568217732988. 14. Wang HS, Kim HS, Ju CI, Kim SW. Delayed bone cement displacement following balloon kyphoplasty. …

Effectiveness of Erector Spinae Muscle Block in Vertebral Oncologic Fracture.

Objectives An observational, retrospective, longitudinal, and analytical study aimed to evaluate the effectiveness of the erector spinae plane (ESP) block in managing pain in patients with vertebral fractures secondary to tumoral activity. This study included patients treated at the Pain Clinic who underwent ESP block. The objectives were to describe demographic characteristics, oncological diagnosis, vertebral fracture features, imaging techniques, medications used, and the level of ESP block. Additionally, pain levels were assessed using a numerical analog scale, and the consumption of opioi

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… Vertebral fractures can be treated using vertebroplasty and kyphoplasty techniques; however, not all patients are candidates for these procedures. …

Post-kyphoplasty secondary vertebral compression fractures in Vietnamese patients: A single-center prospective cross-sectional study.

BACKGROUND: Despite its well-known effectiveness in vertebral compression fractures (VCFs), kyphoplasty could also bring the risk of developing subsequent VCFs post-augmentation, especially at adjacent vertebrae, which has been rarely reported in Asian countries. METHODS: In this cross-sectional study, we performed cement augmentation on 69 vertebrae in 65 patients at the Spine Surgery Department, Viet Duc University Hospital, from June 2019 to November 2020. Cement augmentation was performed on 69 vertebrae in 65 patients. They then were followed and assessed for subsequent VCFs every 3, 6,

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… Load shift of the intervertebral disc after a vertebroplasty: a finite-element study. Eur. Spine J. 2003;12(4):421–426. doi: 10.1007/s00586-002-0512-9. 5. Daniel Cher e.a. Risk of subsequent vertebral body compression fractures after balloon kyphoplasty. Kyphon Broch. 2006:1–16. 6. …

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From virtual to reality: innovative practices of digital twins in tumor therapy.

BackgroundAs global cancer incidence and mortality rise, digital twin technology in precision medicine offers new opportunities for cancer treatment.ObjectiveThis study aims to systematically analyze the current applications, research trends, and challenges of digital twin technology in tumor therapy, while exploring future directions.MethodsRelevant literature up to 2024 was retrieved from PubMed, Web of Science, and other databases. Data visualization was performed using R and VOSviewer software. The analysis includes the research initiation and trends, funding models, global research distri

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… By combining high-resolution image reconstruction with finite element analysis (FEA), DCGANs simulate the physical responses of bones and soft tissues, especially useful in surgeries like vertebroplasty that require high precision for bone tissue manipulation [ 86 ]. … performance | [ 46 ] rAC-GAN with digital twin and 5G cloud support | Lung cancer patient clinical data | AUC reached 0.92 and 0.93, predictive performance consistent with epidemiological statistics | [ 73 ] ReconGAN and finite element model | Spine metastasis patient clinical data | Evaluated post-vertebroplasty …

Prognostic Factors after Surgical Treatment for Spinal Metastases.

Study designA retrospective multicenter case series was conducted.PurposeThis study aimed to investigate survival and prognostic factors after surgery for a metastatic spinal tumor.Overview of literaturePrognostic factors after spinal metastasis surgery remain controversial.MethodsA retrospective multicenter study was conducted. The study participants included 345 patients who underwent surgery for spinal metastases from 2010 to 2020 at nine referral spine centers in Japan. Data for each patient were extracted from medical records. To identify the factors predicting survival prognosis after su

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… Biopsy and vertebroplasty were excluded from the surgical intervention. …

Psychometric properties and clinical utility of the EORTC QLQ-BM22 in patients with bone metastases: a systematic review.

BackgroundThe European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for bone metastases 22 (EORTC QLQ-BM22) is a site-specific health-related quality-of-life instrument for patients with bone metastases. However, modern treatments and extended survivorship have introduced new toxicity profiles and clinical challenges. We systematically assessed the measurement performance of QLQ-BM22 to determine if contemporary evidence supports updating the module.MethodsA search was conducted using Medline, Embase, and Cochrane Central Register of Controlled Trials from in

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… Efficacy of percutaneous vertebroplasty for the relief of osteoblastic spinal metastasis pain. Exp Ther Med. 2021;22(1):727. doi: 10.3892/etm.2021.10159. 48. Zuo D., Sun M., Mu H., et al. … Safety and clinical efficacy of microwave ablation combined with percutaneous vertebroplasty in the treatment of multisegmental spinal metastases. J Cancer Res Ther. 2024;20(2):712–717. doi: 10.4103/jcrt.jcrt_558_23. 58. He Y., Zhu X., Wu C., Wang T., Yan B., Wang J. …

Myeloma Bone Disease: The Osteoblast in the Spotlight.

Lytic bone disease remains a life-altering complication of multiple myeloma, with up to 90% of sufferers experiencing skeletal events at some point in their cancer journey. This tumour-induced bone disease is driven by an upregulation of bone resorption (via increased osteoclast (OC) activity) and a downregulation of bone formation (via reduced osteoblast (OB) activity), leading to phenotypic osteolysis. Treatments are limited, and currently exclusively target OCs. Despite existing bone targeting therapies, patients successfully achieving remission from their cancer can still be left with chro

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… Current management strategies for MBD include: (1) pain relief, (2) interventional radiology (e.g., vertebroplasty), (3) orthopaedic interventions, and (4) bone targeted pharmacological treatments. … Radiological procedures, such as vertebroplasty, can be helpful in the treatment of vertebral compression fractures. Orthopaedic interventions can either be prophylactic (for severe and/or unstable bone disease) or for fracture repair. …

Radiofrequency sacroplasty as a pain treatment for symptomatic sacral destruction due to prostate metastasis: a case report and a review of the literature.

In progressive malignant diseases such as prostate cancer, metastatic bone destruction is a frequent cause of chronic, debilitating pain. Pathological fractures of the sacrum can lead to complete immobility in patients. Cement augmentation of the sacrum has proven effective in treating sacral insufficiency fractures, resulting in significant pain reduction and improved mobility. In recent years, this technique has also been applied to pathological fractures of the sacrum. We present a case of successful treatment of prostate cancer-induced sacral bone infiltration and destruction using advance

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… Pain management in pathologic sacrum fracture with CT guided balloon sacral vertebroplasty. Rofo 2012;184:578–80. 10.1055/s-0031-1299370. 25. Shah RV. Sacral kyphoplasty for the treatment of painful sacral insufficiency fractures and metastases. …