Beyond Diagnosis: Integrating Interventional Radiology, Orthopaedic Stabilisation and Radiotherapy in the Management of Bone Tumours and Metastases

Bone tumours and skeletal metastases represent complex musculoskeletal conditions requiring simultaneous consideration of diagnosis, tumour control, skeletal stability, fracture prevention, neurological protection, pain relief, and quality of life. The increasing survival of cancer patients has led to a growing population living with skeletal metastases and complications such as pain, pathological fractures, spinal instability, spinal cord compression, and impaired mobility. Although systemic therapy, surgery, and radiotherapy remain fundamental, advances in image-guided interventions have expanded the role of interventional radiology (IR) in diagnosis, local tumour control, and mechanical stabilisation. Image-guided biopsy, tumour embolisation, thermal and cryoablation, cementoplasty, vertebral augmentation, and percutaneous osteosynthesis provide minimally invasive treatment options, particularly for patients with painful or structurally compromised lesions who may not tolerate extensive surgery. Orthopaedic oncology remains essential for lesions associated with mechanical instability, impending or established fractures, deformity, or major structural destruction requiring reconstruction. Radiotherapy continues to play a key role in local tumour control and palliation, with conventional external beam radiotherapy providing effective symptom relief and stereotactic body radiotherapy offering durable local control in selected patients. Optimal management increasingly depends on multidisciplinary collaboration among radiologists, interventional radiologists, orthopaedic surgeons, radiation and medical oncologists, pathologists, and rehabilitation specialists. Assessment tools such as the Mirels’ score and Spinal Instability Neoplastic Score (SINS) support standardised risk assessment and treatment planning. Combined approaches, including ablation with cementoplasty, surgical stabilisation followed by radiotherapy, and minimally invasive stabilisation with systemic therapy, are increasingly used. Emerging technologies such as artificial intelligence, radiomics, three-dimensional navigation, cone-beam computed tomography (CT), and robotic assistance may further enhance precision and outcomes. This review highlights the evolving roles of IR, orthopaedic stabilisation, and radiotherapy and emphasises their integration within multidisciplinary treatment pathways for bone tumours and skeletal metastases.