Current management of brain metastases: a narrative review

Purpose: Brain metastases are increasingly encountered in contemporary oncology because patients with metastatic cancer are living longer and central nervous system involvement is being detected more frequently. At the same time, treatment strategies have become more complex, evolving beyond palliative whole-brain radiotherapy toward multidisciplinary, individualized approaches. This review aims to summarize current treatment principles for brain metastases and provide a practical overview for clinicians involved in primary, secondary, and specialist cancer care.Current concepts: Current management of brain metastases is determined by neurological symptoms, lesion size, lesion number and location, extracranial disease status, molecular subtype, and expected prognosis. Corticosteroids remain important for symptomatic edema control, whereas surgery and stereotactic radiosurgery play central roles in local treatment. Whole-brain radiotherapy is now used more selectively, and hippocampal avoidance and memantine have improved its tolerability in appropriately selected patients. In parallel, advances in targeted systemic therapies with intracranial activity have expanded treatment options for selected molecular subtypes, particularly in non-small cell lung cancer, human epidermal growth factor receptor 2-positive breast cancer, and BRAF-mutant melanoma.Discussion and conclusion: Contemporary management of brain metastases depends less on any single modality than on the appropriate integration of local and systemic therapies. Optimal treatment therefore requires careful patient selection and close multidisciplinary collaboration. As surgical techniques, radiation delivery methods, and systemic therapies with central nervous system activity continue to evolve, brain metastases should no longer be viewed solely as a uniformly terminal manifestation of cancer, but rather as a condition in which meaningful disease control, symptom relief, and functional preservation can often be achieved.