<p>Cadmium (Cd) and arsenic (As) co-contamination in global paddy soils remains a persistent issue, with region-specific, scalable, and cost-effective solutions still lacking. This study monitors the entire growth cycle of local rice varieties cultivated in polluted farmland downstream of a typical polymetallic mining area in southern China. Two efficient technologies for managing Cd-As co-contaminated paddy soils were identified through evaluation of rice yield, grain safety, and economic benefits. The paper discusses the core mechanisms by which alkaline immobilization materials mitigate pollution by adjusting soil pH, as well as the unique pathway of organic immobilization materials in reducing Cd and As availability by promoting the formation of iron-manganese oxides and enhancing adsorption complexation. It also proposes the application of foliar inhibitors from the booting to filling stages to strengthen Cd and As barriers in agricultural practice. While combined management strategies have demonstrated potential advantages over single measures in most studies, this research emphasizes that specific effects must be customized based on actual soil conditions and rice variety characteristics, revealing that combined measures are not always the optimal solution. Additionally, practical advice is provided to farmers: when selecting immobilization materials, a comprehensive evaluation of yield, quality, and economic benefits should be considered rather than focusing solely on material costs. This study optimizes Cd-As remediation strategies and provides a practical paradigm for the safe and efficient production of contaminated paddy fields.</p> Graphical Abstract <p></p>