title: Clinical Decision Making: Integrating Advances in the Molecular Understanding of Spine Tumors.
abstract: METHODS
  Literature review.
  
  
  OBJECTIVE
  To describe advancements in molecular techniques, biomarkers, technology, and targeted therapeutics and the potential these modalities hold to predict treatment paradigms, clinical outcomes, and/or survival in patients diagnosed with primary spinal column tumors.
  
  
  BACKGROUND
  Advances in molecular technologies and techniques have influenced the prevention, diagnosis, and overall management of patients diagnosed with cancer. Assessment of genomic, proteomic alterations, epigenetic, and posttranslational modifications as well as developments in diagnostic modalities and targeted therapeutics, although the best studied in nonspinal metastatic disease, have led to increased understanding of spine oncology that is expected to improve patient outcomes. In this manuscript, the technological advancements that are expected to change the landscape of spinal oncology are discussed with a focus on how these technologies will aid in clinical decision-making for patients diagnosed with primary spinal tumors.
  
  
  METHODS
  A review of the literature was performed focusing on studies that integrated next-generation sequencing, circulating tumor cells/circulating tumor DNA, advances in imaging modalities and/or radiotherapy in the diagnosis and treatment of cancer.
  
  
  RESULTS
  We discuss genetic and epigenetic drivers, aberrations in receptor tyrosine kinase signaling, and emerging therapeutic strategies that include receptor tyrosine kinase inhibitors, immunotherapy strategies, and vaccine-based cancer prevention strategies.
  
  
  CONCLUSIONS
  The wide range of approaches currently in use and the emerging technologies yet to be fully realized will allow for better development of rationale therapeutics to improve patient outcomes.
  
  
  METHODS
  N/A.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Nancy
authors.initials: N
authors.lastname: Abu-Bonsrah
authors.affiliation: Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Bilsky
authors.affiliation: Oxford Spinal Unit, Oxford University Hospitals, Oxford, UK.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Reynolds
authors.affiliation: Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Rhines
authors.affiliation: Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Ilya
authors.initials: I
authors.lastname: Laufer
authors.affiliation: Spine Service, Center for Orthopaedics and Traumatology (OUC), University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Disch
authors.affiliation: National Center for Spinal Disorders, Buda Health Center, School of PhD Studies, Semmelweis University, Budapest, Hungary.
authors.forename: Arpad
authors.initials: A
authors.lastname: Bozsodi
authors.affiliation: Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Shreyaskumar R
authors.initials: SR
authors.lastname: Patel
authors.affiliation: Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Chetan
authors.initials: C
authors.lastname: Bettegowda
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D000066491:Clinical Decision-Making; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D040901:Proteomics; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor