Is it preferable to offer hypofractionated SRT over single fraction SRS for brain metastases?  

For bulkier lesions, or somewhat bulky lesions in bad locations (i.e. brainstem) I much prefer to use a 3-fraction approach, with admittedly less data to support it. We do, however, know that necrosis risks become significant with tissue V12 (single fraction) of >10-20 ml, so for patients with b...

For postoperative cases or brainstem locations, I favor HSRT (3-5 fxs). In the postop setting, a larger CTV is needed. In the olden days, we used to treat surgical cavities with SRS but observed marginal recurrences in the meninges (area of incision) adjacent to the cavity. Then we started to inclu...

I agree, for small lesions a one-fraction dose might be preferable, but if lesions are bulkier, then a hypofractionnated regimen might decrease risks of necrosis.... allthough notions on necrosis are still limited.