How do you manage recurrent inoperable chest wall pleomorphic liposarcoma with prior radiation therapy?

Palliatively. But review the case and see if anything could be done differently next time. Local control of STS with proper surgery and radiation should be excellent. Perhaps there was a positive surgical margin that should have been re-resected, perhaps postop RT wasn't properly designed, etc. Without in any way casting blame, these are valuable opportunities to reflect and improve.

Several things are notable about this case

1. Medically inoperable 2 years after GTR. The patient must have had some issues at the time of original surgery.
2. How much time between surg and the start of radiation?
3. Any CTX at original TX.
4. Location of tumor, OAR doses, radiation technique.

These items would be critical in the decision to re TX. I have been part of an active STS (Soft Tissue Sarcoma) group at St. Jude and Detroit Medical Center and we have published on recurrent STS.

The biggest difference now is the availability to do SBRT and also consider BID TX schedule. I have done just a few with SBRT, very short follow up but no discernable difference in acute toxicity compared to BID scheduling.

With gross residual, various total doses ...