What dose/fractionation would you recommend for a large brainstem metastasis?

This is always a difficult clinical decision; for "large" (however one chooses to define this) pontine/medullary/brainstem mets, most have moved away from single fraction SRS to 3 fraction SRS (27 Gy in 9 fractions), based largely on the results of the Italian trial. In this trial, 289 patients with...

The best dose may be 0 Gy for many patients with a large brainstem metastasis due to poor prognosis. Even among carefully selected patients in radiosurgery series median survival is only about 4-6 months (PMID:27478166; PMID:26555507), although there are a minority of patients that live beyond a yea...