<p>Brain metastases represent a significant clinical challenge in oncology, affecting a considerable proportion of cancer patients and traditionally linked to a poor prognosis. This review explores the evolving role of radiotherapy, emphasizing the shift from whole-brain radiation therapy (WBRT) to precise modalities like stereotactic radiosurgery (SRS) and surgical resection. Recent progress in systemic therapies, such as targeted therapies and immunotherapies, has transformed treatment strategies, particularly for melanoma and specific non-small cell lung cancer (NSCLC) genotypes. These advancements are supported by prognostic tools like the Graded Prognostic Assessment (GPA), which combines clinical and molecular data to refine outcome predictions and guide therapy. For patients with favorable performance status, treatment hinges on metastasis characteristics—SRS or surgery suits limited lesions, while WBRT addresses extensive disease. Conversely, those with poor performance status prioritize symptom relief and quality of life, often receiving supportive care or less intensive radiotherapy. Post-treatment, routine imaging surveillance aids in detecting recurrence early, enabling timely interventions such as repeat SRS, surgery, or WBRT. A multidisciplinary, tailored approach is crucial to optimize outcomes and preserve quality of life in managing brain metastases. This review synthesizes current evidence and outlines future directions for personalized, evidence-based brain metastases management.</p>