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Purpose: The SORG-MLA was developed to predict 90-day and 1-year postoperative survival in patients with spinal metastatic disease who underwent surgery between 2000 and 2016. Due to the constant changes in treatment methods, it is essential to perform temporal validation with a recent patient population. Therefore, the purpose of this study was to validate the Skeletal Oncology Research Group machine learning algorithms (SORG-MLA) using a contemporary patient cohort., Methods: This retrospective cohort study investigated patients who received surgical treatment for spinal metastases between January 2017 and July 2021 in two tertiary care centers in the US. Eighteen input variables needed for the SORG-MLA were collected including primary tumor, Eastern Cooperative Oncology Group (ECOG) Performance Status, and nine preoperative laboratory values. Outcomes were defined as mortality at 90-day and 1-year postoperative. Performance was assessed using calibration, discrimination, overall performance, and decision curve analysis., Results: In total, 464 patients were included. The validation cohort varied from the development cohort in multiple variables. Despite these differences, the SORG-MLA continued to perform well on calibration, discrimination (area under the receiver operating characteristic curve [AUC] 0.81 (95% confidence interval [CI], 0.77-0.86) for 90-day, AUC 0.75 (95% CI, 0.71-0.80) for 1-year), Brier score, and decision curve analyses., Conclusions: In spite of recent progress in treating spinal metastases, SORG-MLA for survival in patients with spinal metastatic disease continued to perform well on temporal validation. However, updating the models using a contemporary patient cohort and stratifying by primary tumor could further improve the performance., Competing Interests: Approval: investigation performed at Massachusetts General Hospital, Boston USA. Local Institutional Review Board (IRB) approval was obtained for this study (registration number 2013P002411). Financial disclosures: each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Study Design: Retrospective propensity-score matched, case control study at 2 academic tertiary care centers., Objective: To assess the effect of PE on (1) intraoperative blood loss, defined as conventional estimates of blood loss (EBL) and hemoglobin mass loss, and (2) secondary outcomes in patients with spinal metastases from hypervascular histologies., Background Context: Preoperative embolization (PE) intends to reduce blood loss during surgery for spinal metastases of hypervascular tumors such as renal cell carcinoma. However, studies investigating the effect of PE in hypervascular tumors often consist of small cohorts, do not correct for confounding factors, and have conflicting results., Methods: After propensity score matching (PSM), 46 PE patients were matched to 46 non-PE patients without baseline differences. The constraints of PSM did not allow analysis of patients with tumor volumes>9 cm 3 . Multiple linear regression models were fitted for EBL and hemoglobin mass loss. Poisson regression models were fitted for both intraoperative and postoperative transfusions., Results: There was no difference in EBL (948 mL [IQR 500-1750] vs. 1100 mL [IQR 388-1925], P =0.68) and hemoglobin mass loss (201g [IQR 119-307] vs. 232g [IQR 173-373], P =0.18) between PE and non-PE patients. Other than higher 1-year survival rates (65% vs. 43%, P =0.05) in PE-patients, there were no differences in secondary outcomes. In multiple regression analyses, PE was not associated with decreased intraoperative blood loss, hemoglobin mass loss or perioperative blood transfusions., Conclusions: Our study demonstrated that, for tumors <9 cm 3 , PE did not reduce EBL, hemoglobin mass loss or perioperative blood transfusions in patients undergoing spine surgery for metastases from hypervascular histologies. These findings suggest that urgent spine surgeries indicated for hypervascular histologies should not be delayed based on the availability of PE and accurate detection of pre-operative hypervascularity, beyond histology, will likely be an important determination of future PE utilization for spinal metastases., Level of Evidence: Treatment Benefits, Level III., Competing Interests: Conflicts of Interest and Source of Funding : each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. None of the authors had any conflicts of interests., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Retrospective cohort study., Objective: In general, Multiple Myeloma (MM) patients are treated with systemic therapy including chemotherapy. Radiation therapy can have an important supportive role in the palliative management of MM-related osteolytic lesions. Our study aims to investigate the degree of radiation-induced remineralization in MM patients to gain a better understanding of its potential impact on bone mineral density and, consequently, fracture prevention. Our primary outcome measure was percent change in bone mineral density measured in Hounsfield Units (Δ% HU) between pre- and post-radiation measurements, compared to non-targeted vertebrae., Methods: We included 119 patients with MM who underwent radiotherapy of the spine between January 2010 and June 2021 and who had a CT scan of the spine at baseline and between 3-24 months after radiation. A linear mixed effect model tested any differences in remineralization rate per month (β difference ) between targeted and non-targeted vertebrae., Results: Analyses of CT scans yielded 565 unique vertebrae (366 targeted and 199 non-targeted vertebrae). In both targeted and non-targeted vertebrae, there was an increase in bone density per month (β overall = .04; P = .002) with the largest effect being between 9-18 months post-radiation. Radiation did not cause a greater increase in bone density per month compared to non-targeted vertebrae (β difference = .67; P = .118)., Conclusion: Our results demonstrate that following radiation, bone density increased over time for both targeted and non-targeted vertebrae. However, no conclusive evidence was found that targeted vertebrae have a higher remineralization rate than non-targeted vertebrae in patients with MM., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background Context: Conventional external beam radiation therapy (cEBRT) is used in multiple myeloma (MM) to treat severe pain, spinal cord compression, and disease-related bone disease. However, radiation may be associated with an increased risk of vertebral compression fractures (VCFs), which could substantially impair survival and quality of life. Additionally, the use of the Spinal Instability Neoplastic Score (SINS) in MM is debated in MM., Purpose: To determine the incidence of VCFs after cEBRT in patients with MM and to assess the applicability of the SINS score in the prediction of VCFs in MM., Study Design: Retrospective multicenter cohort study., Patient Sample: MM patients with spinal myeloma lesions who underwent cEBRT between January 2010 and December 2021., Outcome Measures: Frequency of new or progressed VCFs and subdistribution hazard ratios for potentially associated factors., Methods: Patient and treatment characteristics were manually collected from the patients' electronic medical records. Computed tomography (CT) scans from before and up to 3 years after the start of radiation were used to score radiographic variables at baseline and at follow-up. Multivariable Fine and Gray competing risk analyses were performed to evaluate the diagnostic value of the SINS score to predict the postradiation VCF rate., Results: A total of 127 patients with 427 eligible radiated vertebrae were included in this study. The mean age at radiation was 64 years, and 66.1% of them were male. At the start of radiation, 57 patients (44.9%) had at least one VCF. There were 89 preexisting VCFs (18.4% of 483 vertebrae). Overall, 39 of 127 patients (30.7%) reported new fractures (number of vertebrae (n)=12) or showed progression of existing fractures (n=36). This number represented 11.2% of all radiated vertebrae. Five of the 39 (12.8%) patients with new or worsened VCFs received an unplanned secondary treatment (augmentation [n=2] or open surgery [n=3]) within 3 years. Both the total SINS score (SHR 1.77; 95% confidence interval (CI) 1.54-2.03; p<.001) and categorical SINS score (SHR 10.83; 95% CI 4.20-27.94; p<.001) showed an independent association with higher rates of new or progressed VCFs in adjusted analyses. The use of bisphosphonates was independently associated with a lower rate of new or progressed VCFs (SHR 0.47 [95% CI 0.24-0.92; p=.027])., Conclusions: This study demonstrated that new or progressed VCFs occurred in 30.7% of patients within 3 years, in a total of 11.2% of vertebrae. The SINS score was found to be independently associated with the development or progression of VCFs and could thus be applied in MM for fracture prediction and possibly prevention., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)