“True” malignant epidural spinal cord compression (MESCC) is used here to describe a lesion compressing of infiltrating the spinal cord associated with neurologic deficits. Radiotherapy alone is the most common treatment, for which several dose-fractionation regimens are available including single-fraction, short-course and longer-course regimens. Since these regimens are similarly effective regarding functional outcomes, patients with poor survival are optimally treated with short-course or even single-fraction radiotherapy. Longer-course radiotherapy results in better local control of malignant epidural spinal cord compression. Since most in-field recurrences occur 6 months or later, local control is particularly important for longer-term survivors who, therefore, should receive longer-course radiotherapy. It is important to estimate survival prior to treatment, which is facilitated by scoring tools. Radiotherapy should be supplemented by corticosteroids, if safely possible. Bisphosphonates and RANK-ligand inhibitors may improve local control. Selected patients can benefit from upfront decompressive surgery. Identification of these patients is facilitated by prognostic instruments considering degree of compression, myelopathy, radio-sensitivity, spinal stability, post-treatment ambulatory status, and patients’ performance status and survival prognoses. Many factors including patients’ preferences must be considered when designing personalized treatment regimens.

“真正的”恶性硬膜外脊髓压迫症 (MESCC) 在此用于描述与神经功能缺损相关的浸润脊髓的病变压迫。单独放疗是最常见的治疗方法，有几种剂量分割方案可供选择，包括单次、短程和长程方案。由于这些方案在功能结果方面同样有效，因此存活率低的患者最好接受短程甚至单次放疗。较长疗程的放疗可以更好地局部控制恶性硬膜外脊髓压迫。由于大多数现场复发发生在 6 个月或更晚，因此局部控制对于长期幸存者尤为重要，因此他们应该接受较长疗程的放疗。重要的是在治疗前估计存活率，这可以通过评分工具来促进。如果安全可行，放疗应辅以皮质类固醇。双膦酸盐和 RANK 配体抑制剂可能会改善局部控制。选定的患者可以从前期减压手术中获益。考虑到压缩程度、脊髓病、放射敏感性、脊柱稳定性、治疗后行走状态以及患者的表现状态和生存预后的预后仪器有助于识别这些患者。在设计个性化治疗方案时，必须考虑包括患者偏好在内的许多因素。双膦酸盐和 RANK 配体抑制剂可能会改善局部控制。选定的患者可以从前期减压手术中获益。考虑到压缩程度、脊髓病、放射敏感性、脊柱稳定性、治疗后行走状态以及患者的表现状态和生存预后的预后仪器有助于识别这些患者。在设计个性化治疗方案时，必须考虑包括患者偏好在内的许多因素。双膦酸盐和 RANK 配体抑制剂可能会改善局部控制。选定的患者可以从前期减压手术中获益。考虑到压缩程度、脊髓病、放射敏感性、脊柱稳定性、治疗后行走状态以及患者的表现状态和生存预后的预后仪器有助于识别这些患者。在设计个性化治疗方案时，必须考虑包括患者偏好在内的许多因素。