How do you approach hotspots/heterogeneity for palliative radiation plans?

For whole brain, hotspots are usually located superiorly, where the head narrows.

Some options to reduce include: higher energy/mixed beams and supplementing the laterals with field in fields to keep the hotspots lower than 110%. Mixed energy plans look very nice, but consider contouring a brain CTV ...

I think this really is much like real estate--location, location. LOCATION!

In some instances, hotspots may be desirable when treating palliatively and in other circumstances, it might be highly undesirable. My approach is truly based on the disease site, histology, the adjacent or subjacent OARs, ...