Brain metastases occur in 20-40% of patients with advanced disease and this may increase with growing utilisation of imaging in asymptomatic patients and the emergence of increasingly effective systemic therapies. Prognosis varies according to age, performance status, number/volume of brain metastases and extent of extracranial disease. In select better-prognosis patients, local therapy in the form of surgery or stereotactic radiosurgery (SRS) improves outcomes compared to whole brain radiotherapy alone. Given the heterogeneity of patients with brain metastases, treatment needs to be individualised. The complexities of managing these patients will be discussed particularly in the current environment of multiple local and systemic treatment options.