Never. Unless it is nodular leptomeningeal disease recurrence after surgical resection.

In the setting of leptomeningeal disease, I would be concerned about under-covering areas of the brain when trying to spare the hippocampus. Also, the conformal techniques make it more difficult to ensure coverage of the brain surface. As such, I would avoid using hippocampal sparing WBRT in patient...

In general, I would not offer such a patient hippocampal avoidant whole brain radiotherapy. The two exceptions would be: Nodular "lepto" dissemination pattern following resection of a brain met and post-op SRS, which is not true leptomeningeal disease (with no disease in the proximity of the hipp...