IMMUNOTHERAPHY AND ITS ROLE IN METASTATIC SPINAL TUMOR

Spinal metastases are among the most common tumors of the vertebrae and around 40% of cancer patients present with spinal metastases. Spinal metastases are not limited to bone metastases, but sys-temic cancers often metastasize to bone structures in the spinal region and may cause intractable pain, permanent neurological damage and long-term disability for cancer patients due to metastatic spinal cord compression. Breast, lung, prostate, kidney, colorectal cancers, and melanomas are the primary cancer types that most frequently metastasize to the spinal region. Spinal metastases most commonly affect the thoracic spine, even though multiple segments may be affected concomitantly. The man-agement of patients with spinal metastases is particularly complex and challenging, with multiple factors-such as the spinal stability status, primary tumor radio and chemosensitivity, cancer biological burden, patient performance status and comorbidities, and patient’s oncological prognosis-influencing the clinical decision-making process. Over the past two decades, substantial progress in understanding the mechanisms of carcinogenesis, has enabled the development of new treatment modalities in ad-dition to conventional treatments. With technological advances in diagnostic imaging techniques and advances in cancer treatment, overall survival rates prolonged associated with the increasing number of patients with spinal metastases. Although different scoring systems were developed in order to system-atize and support this process, genomic analysis data, different mutation types, and molecular structure are not included in these algorithms, which can cause difficulties in the surgical management of spinal metastases and lead to difficulties in determining the optimal treatment strategy. For this reason, it is important for spine surgeons to closely follow advances and efficiency of immunotherapy, targeted therapies, cancer vaccines, and chimeric antigen receptors. A multidisciplinary, personalized approach, enriched by the expertise of each involved specialty is crucial for making a decision about treatment options in cases of spinal metastases. This chapter will discuss the current status of immunotherapy in cancer treatment and its effectiveness in the diagnosis and treatment of spinal metastases.