How would you manage a patient with bilateral adrenal metastasis if SBRT is not an option?  

What would be an appropriate dose/fractionation scheme for palliation of adrenal metastases from breast cancer if not using SBRT?

What are the endocrinologic implications if the patient receives radiation to one adrenal gland now, and requires subsequent palliative radiation to the contralateral adrenal gland in the future?