Would you perform unilateral or bilateral hippocampal avoidant whole brain RT in a patient with a prior SRS to a small hippocampal metastasis?

I would recommend bilateral HA-WBRT and memantine in this situation.

The role for HA-WBRT is shrinking over time with a diminishing patient population between the expanding role of SRS for multiple brain mets and no role for cranial RT for poor prognosis patients with no/limited systemic therapy op...

In short, I agree with Dr. @Dr. First Last. No viable, macroscopic disease in the hippocampus so reasonable to offer HA-WBRT.

In the general/longer version:

The tradeoff of HA-WBRT vs WBRT is the potential benefit of cognitive sparing via radiation dose reduction vs the risk of CNS failure in the hi...