Ongoing corticosteroid therapy for malignant spinal cord compression in palliative care

Although evidence to guide the dosage and duration of ongoing corticosteroid therapy for malignant spinal cord compression in palliative care is unclear, a reasonable approach is to base the regimen on whether definitive management is planned—see Approach to managing malignant spinal cord compression in palliative care and seek specialist advice.

For patients with palliative care needs who have malignant spinal cord compression and will undergo definitive management, in consultation with a specialist, consider:

1dexamethasone 8 to 16 mg orally, daily until surgery is completed or radiotherapy is started. For advice on stopping dexamethasone, see Rationalising corticosteroids used for symptom or complication management in palliative care dexamethasone

OR

1dexamethasone 8 to 16 mg subcutaneously or intravenously, daily until surgery is completed or radiotherapy is started. For advice on stopping dexamethasone, see Rationalising corticosteroids used for symptom or complication management in palliative care. dexamethasone

For patients with palliative care needs who have malignant spinal cord compression and will not undergo definitive management, in consultation with a specialist, considerNational Institute for Health and Care Excellence (NICE), 2008:

1dexamethasone 4 to 8 mg orally, daily. Review response at 7 days; if no benefit is seen, stop dexamethasone, or if beneficial, continue for another 7 days. For advice on stopping dexamethasone, see Rationalising corticosteroids used for symptom or complication management in palliative care dexamethasone

OR

1dexamethasone 4 to 8 mg subcutaneously or intravenously, daily. Review response at 7 days; if no benefit is seen, stop dexamethasone, or if beneficial, continue for another 7 days. For advice on stopping dexamethasone, see Rationalising corticosteroids used for symptom or complication management in palliative care. dexamethasone

If symptoms of spinal cord compression return after the course of dexamethasone is completed, seek specialist advice.