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Brain metastases are the most dreaded complication of systemic cancer, affecting approximately 170,000 people a year, a far greater incidence than primary brain tumors. Advances in modern chemotherapy have led to an improved control of system cancers, often with agents that poorly penetrate the central nervous system, resulting in an increasing incidence of brain metastases. Traditional chemotherapy has had little impact on brain metastases. The main therapeutic option is radiation therapy, and in a small number of patients - surgery. However, refinements in all of these treatments offer some positive outcomes and an increased ability to stratify patients based on certain criteria.