- Not indicated as the immediate treatment for malignant spinal cord compression
- Given after (not always)
- Decompressive spinal surgery, OR
- Local radiotherapy
- Most chemo-sensitive tumors are also radio-sensitive
- Often preferable to give local radiotherapy in such cases, to deal with the anatomical cause of the cord compression without having to consider the fitness of the patient for what may be life-threatening treatment with chemotherapy.
- Teratoma, yolk sac tumor, choriocarcinoma or a malignant molar pregnancy, are the (rare) causes of spinal cord compression where chemotherapy is more effective than radiotherapy, and should be the treatment of choice following initial tissue diagnosis.
- Specific tx
- Small cell lung Ca
- Radiotherapy → chemotherapy
- Prostate ca
- Radiotherapy → chemotherapy and hormonal therapy
- Lymphoma
- If MSCC give Radiotherapy → chemotherapy when definitive histo is back
- Denusomab
- monoclonal antibodies RANKL
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