How do you treat a radioresistant (e.g. RCC or melanoma) oligometastases in a weight-bearing bone after surgical resection and stabilization?

Let's assume we are dealing with a femoral met. If the surgeon just puts an intramedullary (IM) nail through the tumor (tumor not resected), the whole length of the nail will have to be treated as it carries the tumor cells with it as it goes down through the medullary canal. In this situation, external beam RT will be the way to go. I have seen surgeons who open a window in the bone to curettage all the metastatic tumor (usually if they make an effort to remove the tumor, they should be able to get it all) before putting in an IM nail and bone cement (I have always worked in places with fellowship trained orthopedic oncologists). In that case, only the extent of the bone met needs to be covered. Now, we are dealing only with microscopic disease and there is really no good data on using SBRT for microscopic disease. Again, I would recommend external beam RT.