Systemic therapies for the management of cancers with spinal metastases

Management of spinal metastatic disease aims to improve the quality of remaining life in patients who have potentially limited survival. The treatment strategy necessitates multimodality, multidisciplinary involvement. Systemic therapies primarily aim to control systemic spread of the primary cancer. The armamentarium of systemic therapies includes traditional chemotherapy, bone-modifying agents, hormonal therapy, targeted molecular therapy, immunotherapy, and radioisotopes. The newer systemic therapies have resulted in a significant increase in overall survival of patients with metastatic disease. Consequently, treatment strategies must aim to achieve lasting local control of the spinal metastasis. The overall treatment strategy for an individual patient is planned based on a careful consideration of the anticipated survival, medical comorbidities, and the general condition of the patient.