Do you routinely recommend SRS to the surgical bed after resection of a single brain metastasis?

At our institution it is routinely done although local control reported in literature varies from 60 to 85 percent. One problem with this approach is defining the surgical cavity target accurately. To overcome this, retrospective data suggests giving 2mm margin around the cavity to improve local control. This approach is being tested in a randomised study comparing SRS to while brain RT

As @Dr. First Last mentioned, the randomized trial is nearly complete and we try to put these patients on protocol if at all possible to generate the level I evidence we need to make this decision. Off protocol, I prefer observation over SRS to the cavity and treating recurrent disease with SRS. This does require regular follow-up but in some respects is even "choosing wiser" since 50% of patients don't require treatment at all or develop distant brain mets before their cavity becomes a problem....