When future immunotherapy is anticipated, do you alter brain metastasis SRS dose, margin, fractionation, or other factors in an attempt to decrease the risk of symptomatic radionecrosis?

No, I do not alter my radiotherapy volumes or dose for either active or planned immunotherapy. Much of the current data with concurrent ICI and SRS is from small retrospective observational cohorts but in general, meta-analyses of concurrent PD-1/PD-L1 inhibitors with SRS have demonstrated improved ...