NCCN Guidelines for Treatment of Brain Metastases

Basically for patients with 1 to 3 lesions, they favor surgery if the lesions are accessible and if the patient has limited systemic disease. If the lesions are exquisitely radiosensitive (e.g. small cell or lymphoma) then whole brain radiation is preferred.

After resection whole brain postOp radiation is the standard but is optional in radioresistant tumors (e.g. melanoma, renal cell or sarcoma). For those not surgical candidates then whole brain or radiosurgery (particularly for radioresistant) see guideline 1.

For those with 4 or more lesions they favor whole brain +/- radiosurgery. see guideline 2