A complete resolution of spinal epidural metastases following systemic therapy, consisting of chemotherapy and/or hormonal therapy, is reported in four patients with breast carcinoma. Remissions were of substantially longer duration than previous remissions induced by radiotherapy. Single systemic therapy is an underestimated way of treatment for spinal epidural metastases. This way of treatment should be considered when radiotherapy has failed. Under certain circumstances it might even be considered as primary treatment. The protracted remissions following systemic therapy, even in the case of a complete myelographic block, warrant further clinical studies concerning this mode of treatment.