“…The only limit of SRS is represented by the need to create a safe distance between the tumor and the spinal cord, which is indeed the aim of SS in high grade ESCC [16] , [22] , [47] , [48] , [49] , [50] . Recently, Cofano et al proposed the Neurologic Stability Epidural compression (NSE) score with the aim to translate all these concepts in a practical score evaluating the need for surgery in patients with MESCC, according to the latest evidence and assessing ASA, performance status, neurological status, spine stability and ESCC [28] . In the setting of a more comprehensive approach with SRS as a new and relevant treatment option, SS has carved out a key role in MESCC treatment, creating the adequate conditions for radiations [2] , [6] , [7] , [12] , [20] , [22] , [26] .…”