Table 3.
The NOMS decision framework
| Neurologic (N) | Oncologic (O) | Mechanical (M) | Systemic (S) | Decision |
|---|---|---|---|---|
| Low-grade ESCC+no myelopathy | Radiosensitive | Stable | cEBRT | |
| Radiosensitive | Unstable | Stabilization followed by cEBRT | ||
| Radioresistant | Stable | SRS | ||
| Radioresistant | Unstable | Stabilization followed by SRS | ||
| High-grade ESCC±myelopathy | Radiosensitive | Stable | cEBRT | |
| Radiosensitive | Unstable | Stabilization followed by cEBRT | ||
| Radioresistant | Stable | Able to tolerate surgery | Decompression/stabilization followed by SRS | |
| Radioresistant | Stable | Unable to tolerate surgery | cEBRT | |
| Radioresistant | Unstable | Able to tolerate surgery | Decompression/stabilization followed by SRS | |
| Radioresistant | Unstable | Unable to tolerate surgery | Stabilization followed by cEBRT |
Adapted from Chang SY, et al. Orthop Surg 2019;11:552-9 [35].
NOMS, neurologic, oncologic, mechanical, and systemic; ESCC, epidural spinal cord compression; cEBRT, conventional external beam radiation; SRS, stereotactic radiosurgery.