Is it reasonable to delay radiation therapy following surgical decompression for a patient with spinal cord compression if systemic therapy must be started as soon as possible?  

I think it's unwise to delay RT for the usual solid tumor. 1) Surgical decompression seldom removes much tumor. 2) Most of these pts have already received significant chemo decreasing the chances of a meaningful response. 3) A rapid hypofractionated course of RT can usually be given resulting in onl...

I can see no obvious indication for a systemic treatment to displace radiotherapy unless the case is a very sensitive tumor such as lymphoma. In that case, I would go in first with systemic treatment and then consider that I didn't need the RT.

I've had one patient who had surgical decompression and was resumed on chemotherapy for metastatic breast cancer. It was discussed at tumor board for unrelated reasons (not referred to rad onc) and medical oncology stated that risk/benefit of pausing chemotherapy was very high. We decided to accept ...

Palliation should be delivered with a single 8 Gy fx. Increasing complexity of the plan will consume time, and systemic therapy in the setting of cord compression is aggressive and of low prospect of long-term cure or benefit.