Abstract
The incidence and survival of patients with brain metastases is increasing which stresses the importance of treatment decisions regarding local control and toxicity. Unfortunately, the literature (that usually forms the backbone of treatment guidelines) encompasses mostly retrospective analysis of a wide variety of cancers and clinical presentations, and only limited data of the intracranial effects of novel systemic agents is available. The extrapolation of the literature to the individual patient should therefore be done with caution. For example, until more reliable prediction models are available, treatment guidelines should better avoid categorization of patients according to cut-off values (e.g. tumor size or number of metastases) to prevent suboptimal treatment decisions. For each patient the multidisciplinary team has to take all the individual factors that determine the prognosis into account and discuss the best options regarding symptomatology, local control and toxicity. This approach secures a tailored and optimised treatment strategy for every patient.