Malignant epidural spinal cord compression: the role of external beam radiotherapy

Spinal cord compression is a common complication of metastatic malignancy. If not diagnosed and treated early when the patient is still able to ambulate, outcomes and survival are poor. The purpose of this study is to review treatment options for patients presenting with metastatic spinal cord compression and emphasize the importance of early diagnosis. This review also aims to highlight the need for ongoing research to improve patient outcomes.

Recent literature suggests that treatment choices should take into account overall patient prognosis and ambulation status at diagnosis. In particular, poor prognosis patients can be treated with short courses of radiation and longer courses of radiation may be associated with better local control and therefore should be considered for good prognosis patients. Patient prognosis can be estimated using validated scoring systems. MRI screening may be of benefit in selected patient groups deemed at high risk of developing spinal cord compression.

Despite being a common complication of metastatic bone disease, there is a paucity of high-level evidence to guide treatment practice. Current and future randomized trials are vital.