Orthopaedic Management of Bone Metastases from Lung Cancer

Background/Objectives: Bone metastases from lung cancer can cause pain, pathological fracture, spinal instability, metastatic spinal cord compression and loss of independence. Lung cancer-specific evidence for orthopaedically relevant local management remains fragmented. This review assessed outcomes across spinal, appendicular and pelvic skeletal disease, while explicitly examining the anatomical distribution and limitations of the evidence. Methods: PubMed, Web of Science, Europe PMC and Scopus were searched for original studies published from January 2015 to December 2025. Eligible studies evaluated orthopaedic, surgical, minimally invasive or percutaneous skeletal interventions, including radiotherapy when combined with or directly compared with an orthopaedically relevant local strategy. Two reviewers independently screened studies, extracted data and completed the full Joanna Briggs Institute checklist applicable to each design. Findings were synthesised narratively, with evidence certainty assessed using GRADE. Results: Thirty-three studies comprising 3585 participants with lung cancer were included; 26 were retrospective observational studies. Thirty studies predominantly evaluated axial disease, mainly spinal metastases, whereas only six included appendicular lesions; these categories were not mutually exclusive. Local interventions were associated with pain relief, maintenance or recovery of ambulation, neurological improvement and local symptom control in selected patients. Comparative survival findings were inconsistent and vulnerable to selection bias and confounding by indication; no causal survival benefit of surgery was established. Complication patterns differed by intervention type. Overall certainty was low to very low and was weakest for appendicular and pelvic disease. Conclusions: Orthopaedic management can be clinically important for preserving function and controlling mechanical or neurological complications, but the evidence is substantially stronger for spinal than for extraspinal disease. Treatment should remain multidisciplinary and individualised. The proposed decision frameworks are conceptual and guideline-informed rather than validated treatment algorithms.