In many patients with brain metastases, the primary therapeutic aim is symptom palliation and maintenance of neurologic function, but in a small selected cohort, long-term survival and even cure are possible. Central nervous system failures might develop after initial treatment, either locally (regrowth of a previously treated lesion), regionally (elsewhere in the brain parenchyma), or even in the form of leptomeningeal dissemination, the latter carrying the worst prognosis. Some of these failures will not require local therapy because they develop in the terminal phase of general cancer progression where active brain metastasis treatment is neither expected to prolong survival nor improve the patient’s quality of life. At the other end of the spectrum, patients with limited, brain-only, relapse require effective intracranial disease control as a prerequisite for extended survival. The present chapter reviews reirradiation with brachytherapy, stereotactic radiosurgery, fractionated stereotactic radiotherapy and whole-brain radiotherapy.
