Would you recommend radiation for an unresectable chest wall recurrence after two prior courses of radiation?  

The answer depends on multiple factors: 1) How extensive is the present disease 2)Is there evidence of distant mets 3) What was the prior dose of RT and when 3) What types of systemic therapy have been used, what was the response and when 4) What is the patient's overall condition 5) Does the skin ...

Agree with above. As we see more and more local only recurrences this is a challenge. At Cleveland Clinic, we offer hyperthermia and radiation therapy with twice weekly treatment in cases like this.   Alternatively, once can consider chemoradiation or altered fractionation as well.