Malignant Bone Tumors: Pathological Mechanisms, Current Therapies, and Future Directions

Abstract

Malignant bone tumors represent a rare yet aggressive class of cancers with complex pathophysiological mechanisms and significant therapeutic challenges. This review summarizes the current understanding of their pathological processes and treatment strategies. It first examines the molecular and environmental carcinogenic mechanisms of bone tumors, highlighting the potential roles of nitrite-induced genetic mutations and tumor microenvironment alterations. The discussion then focuses on bone cancer pain, a major clinical issue, outlining its molecular mechanisms—including acidosis, osteolytic activity, and neural inflammation—and the progress in pharmacological and integrative management approaches. Modern treatments, including bisphosphonates, RANKL inhibitors, radiopharmaceuticals (e.g., ⁸⁹SrCl₂ and ¹⁸⁸Re-HEDP), and traditional Chinese medicine formulations, are evaluated for their efficacy and limitations. Finally, the paper proposes future directions emphasizing early diagnosis via liquid biopsy, optimization of multimodal therapy, and personalized medicine. Through a synthesis of current research and emerging prospects, this review aims to provide a foundation for improving clinical outcomes and guiding future research on malignant bone tumors.