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The purpose of this review is to present current therapeutic approaches to brain metastases in elderly patients. With increases in life expectancy and advances in neuroimaging techniques, the incidence of elderly patients with brain metastases is increasing. However, there is no consensus on standard treatment and the literature regarding therapeutic strategies for these patients is sparse. A review of the recent, relevant literature was performed with attention to surgical and radiation therapy, particularly stereotactic radiosurgery. Although there are limited data regarding therapeutic effects in the elderly group, survival of selected patients can be significantly prolonged, especially when therapeutic approaches are combined. Cancer patients aged 65 years and older with brain metastases appear to have outcomes comparable to younger patients when treated in a similar manner; thus, age should not be a barrier to treatment.