Background:Malignant spinal cord compression has signiifcantly increased hospitalization costs and even with best approach in treatment the disease course remains relatively stable with dire outcomes. Case presentation: The patient was an 80 years old male with the past medical history of hypertension, stroke with chronic right sided weakness, recently diagnosed with non-squamous cell lung carcinoma stage T4N0Mx presently undergoing chemotherapy as outpatient with carboplatin and taxol presented to the emergency room with the chief complaint of right leg pain with weakness and chest pain for 1~2 days. On d 4 of the admission patient complained of chest pain again and a CT angiogram was ordered as part of the work up for chest pain based on high probability for a pulmonary embolus per“Wells Score”. The CT angiogram revealed a large soft tissue mass centered at T5 vertebral body and probable spinal canal invasion. Conclusion:A more favorable outcome requires the input of both a surgeon and a radiation oncologist to ifnd the most effective approach depending on the area involved and the extent of the lesion, and patient’s choice of treatment always must be respected as well. Despite aggressive treatment patient did not respond well and was deteriorating. Options were discussed with the patient, including the futility of care and lack of response. Patient opted to return home with hospice care and was subsequently discharged home with family.