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There is an increasing number of systemic therapies to treat brain metastases of large cell cancers. Trials have showed that whole brain radiotherapy (WBRT) has a detrimental effect on neurocognitive function and quality of life compared to best supportive care. Therefore the indication of WBRT for multiple brain metastases is a matter of debate. Technical advances have made stereotactic radiotherapy (SRT) available in routine clinical practice also for multiple brain metastases. This treatment is attractive in the setting of effective systemic therapies such as immunotherapy and targeted agents, because of its high local tumor control and avoidance of elective brain irradation.

This presentation discusses the role of SRT for multiple brain metastases in the modern multimodality treatment of brain metastases.