Lung cancer is the first malignant tumor in men and the second in women, among which non-small-cell lung cancer (NSCLC) accounts for 80% to 85% of lung cancer, and the incidence of brain metastases in NSCLC patients is 30% to 50%. The prognosis of patients with brain metastases is poor, and the average survival time of patients receiving only supportive care and corticosteroid therapy is only 1-2 months. Patients most often die from intracranial hypertension, brain herniation, and bleeding from intracranial metastases caused by the occupying lesion. The main treatment options for patients with brain metastases include whole brain radiation therapy (WBRT), surgery, and stereotactic radiosurgery, and patients have an average survival time of 6.5-10 months. Treatment is mainly based on radiotherapy, and the main goal is to relieve symptoms and improve the quality of life of patients. According to the 2013 NCCN guidelines, whole brain radiotherapy combined with hormone is the current standard of care for brain metastases in patients with NSCLC brain metastases. For symptomatic brain metastases, cranial radiotherapy is certainly effective and can provide rapid symptom relief with obvious patient benefit, but for patients with asymptomatic multiple brain metastases detected early, there is no clear evidence that preferred radiotherapy is more beneficial to patients. With advances in screening methods, more and more patients with asymptomatic brain metastases are being identified, and the current question is whether chemotherapy is effective and can prolong survival in patients with inoperable asymptomatic brain metastases. Because, in patients with brain metastases, peripheral tumor control remains poor and whole-brain radiotherapy is administered first, which may produce a high recurrence rate. Therefore, the best treatment option for patients with asymptomatic multiple brain metastases from non-small cell lung cancer remains a hot topic of clinical research interest.1 How should patients with advanced NSCLC with asymptomatic brain metastases choose their treatment options? Do they have clinical research evidence? How reliable are they? To this end, we conducted a comprehensive evidence collection and evaluation, and developed an evidence-based treatment plan for the patient’s condition. ultimately, this patient achieved complete remission of brain metastases and long-term survival. The patient was a 42-year-old male admitted with “pelvic pain for 3 months”. Enhanced MRI of the pelvis suggested multiple bone destruction and possible multiple bone metastases. Bone scan showed multiple bone metabolic abnormalities throughout the body, excluding malignant bone lesions. Enhanced CT of abdomen suggested: multiple intrahepatic occupancies, metastases considered, multiple bone metastases. Chest enhancement CT suggested: left subpulmonary occupancy, considered malignant, and enlarged mediastinal lymph nodes. Multiple small nodular shadow in both lungs, consider bilateral lung metastasis. Bone density changes in the left ribs and thoracolumbar spine were considered bone metastases. The patient refused lung puncture and underwent ultrasound-guided liver puncture biopsy. Pathological findings suggested (right lobe of liver puncture) adenocarcinoma with histochemical staining: AB/PAS (+). One-step immunohistochemical labeling, CKAE1/AE3 (++++), CK7 (++++), CK5/6 (-), SP-B (+++), TTF-1 (++++), P63 (-), Hepatocyte (-), AFP9 (-), Ki-67 labeling index of about 15%; combined with the results of external bone puncture suggested: immunohistochemical staining showed scattered small clusters of cells between the fragmented bone The diagnosis of primary lung cancer was stage IV, with liver metastasis, bone metastasis, mediastinal lymph node metastasis and multiple metastases in both lungs. On 2012-12-12, he was reexamined in our department, which indicated that the tumor markers were decreasing and the liver and lung lesions were reduced and controlled, but the bone metastases increased and asymptomatic multiple cranial metastases appeared, which was evaluated as progressive. Through a comprehensive search, our evidence results showed that: 1. For patients with asymptomatic multiple brain metastases, there was no evidence that the first choice of chemotherapy compared with the first choice of radiotherapy and simultaneous radiotherapy and chemotherapy decreased the survival and prognosis of patients; 2. For patients with asymptomatic brain metastases, the available options were pemetrexed + cisplatin, gemcitabine + cisplatin, and targeted therapeutic agents. Based on the above evidence, and also combining the patient’s wishes and the patient’s family, economic conditions and other specific circumstances, we developed the corresponding treatment plan: 1) after giving whole brain radiotherapy combined with gefitinib targeted drugs to achieve intracranial lesion CR; however, in the follow-up efficacy evaluation: peripheral lesion control is possible, but new multiple meningeal metastases appear in the brain; 2) continue oral targeted drugs, while subsequently giving pemetrexed single agent maintenance chemotherapy, the patient obtained CR of intracranial lesions, and tumor markers also showed rapid reduction, and the patient’s general condition improved significantly. The patient’s physical strength gradually recovered, and the patient has survived for more than 2 years with a KPS score of 80, no obvious not reactions, and daily life is not affected.