ArticleJournal of the American Academy of Orthopaedic Surgeons. Global research & reviews2025
Predictive Factors for Failed Nonsurgical Management of Long Bone Metastasis and Myeloma.
Article in Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Diagnostic accuracy of the Mirels score at the humerus in metastatic bone disease: a narrative review.International orthopaedics · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUnderstanding the risk factors for failing nonsurgical management of metastatic bone disease is necessary to determine those patients who will benefit from prophylactic stabilization; however, standard predictive models do not include several clinically relevant factors. The primary and secondary objectives of this study were to evaluate comprehensive patient- and disease-related factors as potential predictors of failure of radiation therapy alone for long bone lesions and overall survival in metastatic disease and myeloma.
methodsAll patients who underwent radiation therapy for long bone metastases at our tertiary care institution from May 2011 to February 2020 were retrospectively reviewed. Of 475 lesions, we excluded those with prophylactic fixation or fracture before radiation therapy, and those <0.5 cm on plain radiographs. Outcomes of the 186 lesions were classified as no progression, progression requiring prophylactic fixation, or progression to pathologic fracture. Blinded radiograph review was done by two orthopaedic oncology surgeons and two musculoskeletal radiologists. Demographic, socioeconomic, lesion, cancer severity, and patient-specific risk factors were identified, and potential predictors were analyzed using backwards stepwise regression.
resultsFollowing radiation therapy, 8.6% lesions underwent prophylactic fixation and 14.0% fractured. Prophylactic fixation was associated with Mirels' score (OR = 1.98, P = 0.025), lesion cortical involvement (OR = 16.96, P = 0.010), and younger patient age (OR = 0.93, P = 0.024). Fracture was associated with lesion cortical involvement (OR = 10.16, P = 0.003) and "low risk" histology (OR = 9.01, P = 0.057). Orthopaedic treatment (either prophylactic surgery or pathologic fracture management) was associated with Mirels' score (OR = 1.62, P = 0.015), lesion cortical involvement (OR = 8.94, P = 0.002), humerus location (OR = 4.19, P = 0.042), and Medicare (OR = 4.12, P = 0.062) or private insurance (OR = 5.69, P = 0.022) compared with Medicaid. ECOG score (OR = 1.28, P = 0.003) was found to be a risk factor for increased mortality after radiotherapy, while "low risk" histology (OR = 0.51, P = 0.029), mixed lesion type (OR = 0.34, P = 0.006), and increased body mass index (OR = 0.95, P = 0.001) were protective factors.
conclusionsRadiograph measurements of cortical involvement were the most clinically relevant for determination of metastatic lesion fracture risk; however, predictors of local failure not addressed in Mirels' score should be considered in clinical decisions about prophylactic fixation. Surgery may be underperformed for histologies commonly considered to be "low risk" for local progression after radiation therapy.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.