Radiotherapy-based multimodal treatment in advanced NSCLC with spinal infiltration: a case series of seven unfavorable patients

Abstract Background Locally advanced non-small cell lung cancer (LA-NSCLC) with spinal invasion presents a rare but challenging clinical scenario. Radical surgical approaches, though potentially curative, are often not feasible due to comorbidities, advanced age, poor performance status or technical inoperability. In this setting, the optimal multimodal treatment strategy including radiotherapy (RT) and systemic treatment remains to be fully defined. Methods We retrospectively analyzed seven patients with stage III/IV NSCLC and radiologically confirmed spinal invasion treated between 2023 and 2025. Treatment modalities included radiotherapy, systemic therapy, and surgical procedures. Patients were retrospectively stratified using the prognostic scoring system proposed by Lei et al. to assess clinical outcomes by risk group. Results Four patients were classified as low-risk (score 4–5), and three as intermediate-risk (score 6–7); no patients fell into the high-risk category. Two low-risk patients showed favorable outcomes, including long-term survival and disease stability, while two succumbed to local progression. All intermediate-risk patients died within 5–13 months due to disease progression. Radical surgery was not feasible in any case. Timely treatment initiation and multidisciplinary care were associated with improved outcomes in selected patients. Conclusion RT-based multimodal treatment appears feasible in selected unfavorable patients with advanced NSCLC and spinal infiltration who are not candidates for radical surgery. The prognostic score can help in risk stratification, though timely therapeutic decision-making is equally critical. However, due to the small sample size, the impact on survival remains uncertain and requires validation in larger studies.