脑转移瘤是晚期癌症的一种潜在的毁灭性并发症，随着局部和全身治疗的进步，脑转移瘤的治疗变得越来越复杂。转移性实体瘤患者的预后改善和生存期延长导致脑转移的患病率和可能发生率激增，影响高达 40% 的实体瘤患者。增强的成像技术有助于更准确、更早地进行检测，从而加深对这种情况复杂情况的理解。传统上，手术和放射治疗是主要的治疗方法，因为大脑内的全身治疗效果有限。然而，新出现的临床数据，特别是黑色素瘤、肺癌和乳腺癌的临床数据，揭示了免疫疗法和靶向疗法等新型全身治疗的有希望的结果。尽管历史上将活动性脑转移患者排除在临床试验之外，但现在正在朝着更具包容性的方法转变。本章深入探讨了与管理脑转移相关的多方面挑战，重点关注系统方法的不断发展以及共同决策的复杂性，全面概述了应对脑转移复杂性的现状和未来方向转移管理。

The management of brain metastases, a potentially devastating complication of advanced cancers, has become increasingly complex with advancements in local and systemic therapies. Improved outcomes and extended survival for patients with metastatic solid tumors have led to a surge in the prevalence and possibly incidence of brain metastases, affecting up to 40% of individuals with solid tumors. Enhanced imaging technologies contribute to more accurate and early detection, shaping the understanding of the intricate landscape of this condition. Traditionally, surgery and radiation stood as the mainstays of treatment because of the limited efficacy of systemic therapies within the brain. However, emerging clinical data, particularly in melanoma, lung, and breast cancers, reveal promising results with novel systemic treatments such as immunotherapy and targeted therapies. Despite the historical exclusion of patients with active brain metastases from clinical trials, a shift is occurring toward a more inclusive approach. This chapter delves into the multifaceted challenges associated with managing brain metastases, with a focus on the evolving landscape of systemic approaches as well as the intricacies of shared decision making, providing a comprehensive overview of the current state and future directions in navigating the complexities of brain metastases management.