Stereotactic radiosurgery (SRS) is a standard approach for appropriately-selected patients with a limited number of brain metastases (BM) at diagnosis. However, in recent years, treatment paradigms have been changing because systemic therapies with intracranial activity are also emerging. Immunotherapy may be considered as upfront treatment for some patients with BM but response rates are generally lower than that expected elsewhere in the body. Immunotherapy may also be administered with SRS because preclinical data shows that this generates a release of tumour antigens that can be used to enhance the effect of treatment inside and outside the brain. Early clinical experience suggests that this combination may be associated with improved BM response rates and local control but high quality data is lacking. This lecture will provide a general overview of the ways that immunotherapy and SRS are used in the management of BM. It will consider how to assess the issue of optimal sequencing of treatment within the context of clinical trials.