Do you routinely offer a stereotactic boost to patients with bulky (>3cm) residual brain metastasis after whole brain radiation for multiple brain metastases?

In general, bulky tumors are resected out. If for some reason a patient with a bulky tumor does receive WBRT for a bulky tumor, I would wait a month or two after for a repeat MRI. If the tumor does shrink it should provide some room to dose escalate.