When offering palliative radiation for spinal cord compression, do you ever "open up the field" if there is evidence of leptomeningeal disease on MRI?

Considering the urgency of the situation and the poor prognosis associated with LMD, my approach is to treat the area causing cord compression. I would treat the offending area of the spine, often using a "one vert body above and below" margin on the gross disease causing the symptoms that I intend to palliate. While it can be useful to extend the target to include a substantial site of disease that would be anticipated to cause pain or cord compression in the coming weeks if left untreated, there is no clear clinical benefit that I am aware of to treat a larger area for LMD specifically. If not doing CSI, I doubt a larger spine field would improve disease outcomes in any way, while it could increase toxicity.

Lastly, I would favor a short course (1-5 fx) in the case of LMD to minimize the time of their remaining life on treatment and expedite initiation of systemic therapy (if they are waiting on us to finish).