Brain metastasis is a common complication of systemic cancer. The management of this complex problem has been controversial over the years. High-dose steroids and whole-brain radiation therapy (WBRT) have been the main treatments in the past. Surgery was established as the gold standard treatment of cerebral metastases in the early 1990s. More recently, radiosurgery has been considered as a possible replacement therapy for metastases less than 3 cm in diameter. Several authors advocate the use of adjuvant WBRT after surgery/radiosurgery, whereas others advise against its routine administration. The aim of this article is to review the current recommendations published in the literature and report on the management strategy followed at The University of Texas M. D. Anderson Cancer Center for treating patients with brain metastases.