What is your approach for an inoperable patient with epidural spinal cord compression who has previously received maximum spinal cord dose during a previous course of radiation therapy?

http://www.ncbi.nlm.nih.gov/pubmed/18642349

This paper highlights motor outcome in patients who had reradiation for cord compression with cumulative BED less than 120 With no RT reacted cord injury. if patient is not a candidate for surgical decompression we have retreated with EBRT and more recently with fractionated SBRT with idea to achieve short tem palliation. Cord complication with RT is underestimated as most patients hav short life expectancy because of metastatic disease and thus not enough time to manifest late effect