西元1895年侖琴發現X光，接著的二十世紀開啟醫學科學、癌症治療、放射治療啟蒙以及發揚光大的一整個世紀。現今處在二十一世紀前葉，醫學上仍然以克服癌症作為主要課題。本文範圍為腦轉移，極少數病患可以得到治癒性的治療，如外科手術、放射手術，大多數仍然在偏向緩解性的症狀控制等治療法中奮鬥探索。逐漸的，在全腦放射治療這個傳統又經典的治療法上，被發現了和化學治療相互作用的關係。尤其是各種標靶治療，免疫節點治療的發明提高了更高的治療反應率以及存活率，甚至於單獨使用osimertinib就可以有效治療非小細胞肺癌的腦部轉移，更加提升了腫瘤科醫師面對腦轉移病患的積極性。全面的評估病患，依據病患病理組織、腫瘤因素、病患因素，配合所有選項：全腦照射、放射手術、外科手術、支持療法、化學治療、標靶治療、免疫節點治療等，去做各個治療法的合併或者排序治療，這是腫瘤科醫師的日常挑戰。

Since 1895 Roentgen discovered x-ray, people opened a century of great development of medical science, cancer treatment, and radiotherapy. Now, in the early of twenty first century, we continue the war against cancer disease. This review article focuses on brain metastases. Few patients with brain metastasis(es) are suitable to have treatment with curative intension that can be surgery and radiosurgery. Most patients with brain metastases have a basket of treatment choices that are all palliative. Today, we have much more experiences about radiotherapychemotherapy interactions in the scene of classical whole brain irradiation. Furthermore, we have new modalities such as target therapy and immunotherapy which comes with high response rate and longer survival. For example, osimertinib alone offers around 90% response rate for some non-small cell lung cancer brain metastases. Oncologist is more confident and aggressive. Evaluating patients throughly from pathology to tumor factor and patient factors, then performing multi-modalities treatments which include whole brain irradiation, radiosurgery, surgery, supportive care, chemotherapy, target therapy, immune checkpoint therapy. Those are daily routines and also huge challenges for oncologists.