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This report reviews the available literature on LMDT approaches and provides consensus recommendations regarding therapeutic decision making, timing, and indications for the use of LMDT in the management of RR\u2010ES. LMDT should be considered on a case\u2010by\u2010case basis to assess appropriateness, optimal timing\/modality, palliative versus curative intent, and its role in relation to chemotherapy. One commonly used LMDT is radiotherapy (RT), which can be delivered through standard, hypofractionated, or stereotactic techniques based on factors including prior RT, tumor size, and\/or location. Chemotherapy can be combined with RT, although prospective data are limited in the relapse setting. Surgery for LMDT not only addresses the tumor but also provides tissue for analysis, though the potential surgical morbidity based on location, extent of resection, and recovery complications should be considered. Interventional radiology approaches also can procure tumor tissue while delivering LMDT; there are several different procedures available based on the location, size, and extent of disease. Finally, a combination of LMDT approaches can be used for patients with RR\u2010ES. Decisions regarding the management of RR\u2010ES should involve a multidisciplinary team and factor in the burden of disease, progression\u2010free interval, life expectancy, toxicity profiles of LMDT, and quality of life. In such patients, informed and shared decision making with patients and their families is paramount.<\/jats:p>","DOI":"10.1002\/cncr.35858","type":"journal-article","created":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T00:44:03Z","timestamp":1745023443000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Consensus recommendations regarding local and metastasis\u2010directed therapies in the management of relapsed\/recurrent Ewing sarcoma"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9295-5554","authenticated-orcid":false,"given":"Chirag","family":"Shah","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Taussig Cancer Institute Cleveland Clinic  Cleveland Ohio USA"},{"name":"Department of Radiation Oncology Allegheny Health Network  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shauna R.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Taussig Cancer Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Taussig Cancer Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Braunstein","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew S.","family":"Dietz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Utah Primary Children\u2019s Hospital  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odion","family":"Binitie","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery H. 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