Abstract
Surgery and radiation therapy are the cornerstone treatments in brain metastasis. However, with the advent of targeted therapy and immune checkpoint inhibitors patients with melanoma brain metastasis have more effective options in disease management. However, surgery and radiation therapy continue to play a large role in the care of melanoma brain metastasis. Whole brain radiation is associated with long-term cognitive sequelae leading to preferential use of stereotactic radiosurgery for selected metastases. This is particularly relevant with improved outcomes with the use of targeted therapies as well as immunotherapies and, hence, living long enough to experience the cognitive decline as can be seen in whole brain radiation. Approximately one-third of patients will die as a result of a progressive intracranial disease. Advances in surgical and radiotherapy treatments for brain metastasis give promise to this grim prognosis. By decreasing morbidity and mortality, greater than 1-year survival is no longer the exception. Furthermore, aggressive treatment of an intracranial disease allows patients time to undergo more novel and promising targeted or immunologic adjunct therapies.
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