28th May 2025

A 51-year-old gentleman with a previous history of a radical nephrectomy three years prior for a T3N0M0 poorly-differentiated renal cell carcinoma presents to the emergency department with a week long history of severe interscapular back pain.

A 51-year-old gentleman with a previous history of a radical nephrectomy three years prior for a T3N0M0 poorly-differentiated renal cell carcinoma presents to the emergency department with a week long history of severe interscapular back pain. He has no other significant past medical history, and he takes no regular medications. He has a sensory level identified. After plain films identified a T4 vertebral wedge fracture, he was subsequently commenced on 16 mg Dexamethasone + PPI and placed on flat bed rest. An MRI whole spine was undertaken, showing a destructive lesion in the T4 vertebral body consistent with a bony metastasis, resulting in compression of the spinal cord at this level. No other vertebral metastases were identified.

What is the best treatment option for this patient?