What is your local control approach to localized relapse of Ewing sarcoma in a site that was previously unresectable and received definitive radiation?

It depends obviously on some other factors including disease-free interval, the site itself, the dose of radiation received, symptoms, etc...

Generally, a combined modality approach is attempted. Second-line chemotherapy with either high-dose ifosfamide, irinotecan/temozolomide, or topotecan/cyclophosphamide is often used. After 4-6 cycles of therapy, re-assess if it is still unresectable and if there is any role for any additional radiation. If not amenable to any local control measures, the decision on how much more palliative chemotherapy to give or not will depend (again) on several factors but would include response to chemo, tolerance to chemotherapy so far, performance status, symptoms due to disease, and patient preference.

I know ...