How would you manage recurrent liposarcoma of the chest wall?

Radical excision of a soft tissue sarcoma with split course radiotherapy, and latissimus dorsi flap to provide a bed for completion radiotherapy. Numerous excisions of local recurrence over 7 years, with further radiotherapy. Now further local recurrence confined to the original excision margin, with no evidence of systemic disease, all against the background of considerable cardiorespiratory disease, but with moderate improvement following redo cardiac surgery.