The role of radiotherapy for metastatic epidural spinal cord compression

Nat Rev Clin Oncol. 2010 Oct;7(10):590-8. doi: 10.1038/nrclinonc.2010.137. Epub 2010 Aug 31.


Radiotherapy alone is the most common treatment for metastatic epidural spinal cord compression (MESCC). Decompressive surgery followed by radiotherapy is generally indicated only in 10-15% of MESCC cases. Chemotherapy has an unclear role and may be considered for selected patients with hematological or germ-cell malignancies. If radiotherapy alone is given, it is important to select the appropriate regimen. Similar functional outcomes can be achieved with short-course radiotherapy regimens and longer-course radiotherapy regimens. Longer-course radiotherapy is associated with better local control of MESCC than short-course radiotherapy. Patients with a more favorable survival prognosis (expected survival of ≥6 months) should receive longer-course radiotherapy, as they may live long enough to develop a recurrence of MESCC. Patients with an expected survival of <6 months should be considered for short-course radiotherapy. A recurrence of MESCC in the previously irradiated region after short-course radiotherapy may be treated with another short-course of radiotherapy. After primary administration of longer-course radiotherapy, decompressive surgery should be performed if indicated. Alternatively, re-irradiation can be performed using high-precision techniques to reduce the cumulative dose received by the spinal cord. Larger prospective trials are required to better define the appropriate treatment for the individual patient.

Publication types

  • Review

MeSH terms

  • Combined Modality Therapy
  • Decompression, Surgical
  • Epidural Neoplasms / complications
  • Epidural Neoplasms / radiotherapy*
  • Epidural Neoplasms / secondary*
  • Epidural Neoplasms / surgery
  • Glucocorticoids / therapeutic use
  • Humans
  • Radiotherapy Dosage
  • Spinal Cord Compression / etiology*
  • Spinal Cord Compression / radiotherapy*
  • Spinal Neoplasms / complications
  • Spinal Neoplasms / radiotherapy*
  • Spinal Neoplasms / secondary*
  • Spinal Neoplasms / surgery


  • Glucocorticoids