When treating the whole brain with hippocampal avoidance, do you ever deliver SIB to gross disease?

There have been several papers and an ongoing trial evaluating the safety and efficacy of including SIB to macrometastatic disease with HA-WBRT. A recently published trial from the UT-Southwestern team was a single-arm phase II trial, which treated 50 brain metastasis patients with HA-WBRT to 20 Gy in 10 fractions with SIB to macro-metastatic disease to 40 Gy in 10 fractions (Westover et al., PMID 32347302).

This approach achieved intracranial control comparable to modern series of sequential WBRT plus SRS, better HVLT outcomes compared to historical trials of conventional WBRT, and overall acceptable toxicity profile.

Important caveats about this trial are that the maximum number of intracranial macro-metastases in this patient population ...