An up-to-date overview of bone metastases management: A systematic review

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.