Should radiotherapy be considered for the initial treatment of brain metastases?

Brain metastases are common complications that occur in 10–50% of patients with cancer, representing a major challenge in oncology. Historically, whole brain radiotherapy (WBRT) has been the mainstay of treatment; however, treatment has been rapidly evolving due to new radiotherapy technologies and systemic therapies changing the treatment framework for several cancers. Prospective randomised studies have shown significantly higher efficacy of stereotactic radiosurgery (SRS) in reducing the detrimental effects of cognitive function and quality of life associated with WBRT while maintaining equivalent survival benefit. So far, SRS has become the standard of care for patients with one to four brain metastases.