How do you approach treatment of brainstem metastases in the setting of prior WBRT?

Depending on the proximity of the WBRT the answer differs. If WBRT is more than 6 months prior I do not alter my prescription.

For more immediate WBRT - say as a post WBRT boost I keep the dose low to a conformal plan. 8-10 Gy single session and 15-18 in three fractions.

For our brainstem mets results...