Improved systemic treatments – including chemotherapy, targeted agents (EGFR/ALK inhibitors in lung cancer, HER2-directed therapy in breast, BRAF/MEK inhibitors in melanoma), immunotherapies (checkpoint inhibitors), and advanced radiotherapy techniques – have modestly extended survival in patients with spinal cord metastases and thus influence the role of surgery [32, 33]. This evidence concerns the gene ALK and lung carcinoma.