What are the key local therapy considerations for patients with malignant pleural effusion, bulky pleural disease, lung metastases and chest wall/diaphragm primary in a patient with Rhabdomyosarcoma or Ewing Sarcoma?  

How should sufficient doses of radiation be delivered when lung metastases, pleural disease are present, constraints are maxed out and significant toxicity is anticipated?

Should the whole lung, whole pleural surface, and primary site RT be delivered at the same time?

Is there a role for surgery in patients with extensive pleural disease?