Integrated management of metastatic spinal tumors: current status and future directions

With improved cancer survivorship, the incidence of metastatic bone disease has risen, and metastatic spinal tumors (MSTs) have emerged as a common yet significant clinical challenge. These tumors may compromise the integrity of vertebral bodies leading to pathological fractures and neurological compromise from nerve root or spinal cord compression dramatically affecting the patient's quality of life. Despite the associated morbidity and mortality, optimal treatment strategies remain elusive. Here, in our review, we provide a comprehensive analysis of the contemporary MST treatment strategies, encompassing surgical interventions, advanced radiotherapy modalities, and evolving systemic therapies including chemotherapeutic and immunotherapeutic approaches. We critically evaluate each modality's development trajectory, clinical efficacy, therapeutic advantages, and inherent limitations. Our analysis reveals a definitive shift toward precision-guided radiotherapy and minimally invasive surgical techniques that balance therapeutic efficacy with reduced morbidity. These findings underscore the necessity for multidisciplinary management and highlight promising avenues for therapeutic innovation. As treatment paradigms evolve, integration of these advanced modalities offers new hope for this vulnerable patient population facing a challenging oncological complication.