How long after initiation of steroids do you typically recommend waiting prior to delivering radiation therapy for spinal cord compression?

This is an interesting question. Because the role of steroids in spinal cord compression has evolved over the last few years (less daily high dose use 96mg or greater), its overall role in MSCC is under scrutiny. Unless, there is a soft tissue mass causing the ESCC, or, where steroids are needed for analgesic purposes, doses of 16 mg or so per day are generally recommended.

In the last decade or so, I have not seen many patients needing urgent RT for neurologic recovery efforts. Most RT interventions for me have been for pain relief and / or post de-compressive surgery. I can't recall once where a once ambulatory patient was paralyzed from MSCC, and subsequently, regained his/ her ability to walk post RT only intervention. I have seen some ...

I don’t specifically wait a certain amount of time. The patient presents to the ER with cord compression they are usually started on dexamethasone. By the time all the consultants are seen, ER physician, neurosurgery, and Rad Onc then simulated for RT it’s at least 6-8 hours often more. More importantly if pt neurologic sx worsen during RT, I usually increase steroid dose or consult neurosurgery for decompression (rare).

I would wait at least 6 hours, preferably 12 hours