An up-to-date overview of bone metastases management: A systematic review
Bibliographic record
Abstract
Introduction: Bone metastases (BM) are a major complication in patients with advanced cancer, resulting in pain, fractures, and other skeletal-related events (SREs) that greatly affect quality of life. Objective: To provide an updated overview of the current management strategies for BM. Methodology: This systematic review adhered to the PRISMA 2020 guidelines and was registered in PROSPERO (CRD42024586182). A comprehensive literature search was performed in July 2024 across PubMed, ScienceDirect, and Scopus, using terms related to BM and Boolean operators (OR, AND, and NOT). The search strategy was refined to only include studies published since January 2020. Randomized controlled trials (RCTs), clinical trials (CTs), and cohort and case-control studies published in English or Spanish assessing various management strategies for BM, such as surgery, radiotherapy, systemic therapies, and supportive care, and reporting data on the outcomes of interest were included. The Newcastle-Ottawa Scale was used for quality assessment. Results: A total of 131 records were retrieved from the searches. After duplicate removal and title and abstract and full-text screening, 27 studies were included in the review: 13 RCTs, 7 CTs, 6 cohort studies, and 1 case-control study with an aggregate sample of 14 672 patients. Radiotherapy, particularly multifractionated regimens and stereotactic body radiotherapy, was shown to improve pain relief and bone stability. Systemic therapies, including immune checkpoint inhibitors and bone-targeted agents, demonstrated efficacy in reducing skeletal-related events. Emerging techniques such as percutaneous vertebroplasty combined with ablative methods demonstrate potential in minimizing complications and improving quality of life. Conclusion: The management of BM continues to evolve, with personalized, multimodal approaches being essential for achieving optimal outcomes. Further research should focus on enhancing predictive models, exploring novel therapies, and integrating bone-targeted agents to reduce complications and improve both survival and quality of life in patients with bone metastases.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.042 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.008 |
| Bibliometrics | 0.016 | 0.015 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".