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This review summarises current multidimensional strategies to improve OV delivery efficiency. First, genetic engineering with deletion of viral genes and insertion of therapeutic genes, markedly enhance viral targeting, safety, and therapeutic capacity. Second, combination therapies with radiotherapy, chemotherapy and immunotherapy can execute microenvironmental preconditioning and either concurrent or sequential administration to improve viral distribution inside tumours, increase local accumulation and enhance immune activation. In addition, modulation of the tumour immune microenvironment helps enhance viral replication and spread in \u2018cold\u2019 tumours, thereby inducing systemic antitumour responses. Finally, carrier\u2010mediated delivery using stem cells, extracellular vesicles, and viral envelope reconstitution provides innovative approaches to overcome systemic delivery barriers. 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