How would you manage an epidural spinal metastasis causing cord compression from rhabdomyosarcoma?

Leptomeningeal spread of rhabdomyosarcoma could result from the dissemination of tumor cells in the CSF by direct extension or by malignant cells growing along blood vessels or nerve sheaths. I would first get a total spine and a brain MRI to assess where there is gross disease present in other parts of the CNS; if the MRI is negative, I would try to perform a spinal tap to assess cytology. If both the MRI and cytospin cytology are negative, I would treat with focal RT rather than CSI. I would, however, apply a generous CTV longitudinally along the spinal cord as the RMS may have spread along the surface of the spinal cord. If the patient is not symptomatic from the spinal cord compression, I would consider induction chemotherapy, since the...