| Tumor and compression | Stable spine | Unstable spine |
|---|---|---|
| Radiosensitive, any ESCC grade | cEBRT | Stabilization → cEBRT |
| Radioresistant, ESCC 0 to 1b | SRS | Stabilization → SRS |
| Radioresistant, high‑grade ESCC, fit for surgery | Separation surgery → SRS | |
| Radioresistant, high‑grade ESCC, unfit for surgery | cEBRT | Stabilization → cEBRT |
NOMS paradigm provides a decision framework that incorporates sentinel decision points in the treatment of spinal metastases. Consideration of the tumor sensitivity to radiation in conjunction with the extent of epidural extension allows determination of the optimal radiation treatment and the need for surgical decompression. Mechanical stability of the spine and the systemic disease considerations further help determine the need and the feasibility of surgical intervention.
| Tumor and compression | Stable spine | Unstable spine |
|---|---|---|
| Radiosensitive, any ESCC grade | cEBRT | Stabilization → cEBRT |
| Radioresistant, ESCC 0 to 1b | SRS | Stabilization → SRS |
| Radioresistant, high‑grade ESCC, fit for surgery | Separation surgery → SRS | |
| Radioresistant, high‑grade ESCC, unfit for surgery | cEBRT | Stabilization → cEBRT |
NOMS paradigm provides a decision framework that incorporates sentinel decision points in the treatment of spinal metastases. Consideration of the tumor sensitivity to radiation in conjunction with the extent of epidural extension allows determination of the optimal radiation treatment and the need for surgical decompression. Mechanical stability of the spine and the systemic disease considerations further help determine the need and the feasibility of surgical intervention.