Objective To evaluate the efficacy and safety of gefitinib for non-small cell lung cancer（NSCLC）with brain metastases in elderly patients. Methods After whole brain radiation therapy，gefitinib （250mg／d） was given in 30 elderly NSCLC patients with multiple brain metastases（treatment group） until disease progression or intolerable toxicity. After whole brain radiation therapy，intravenous infusion of gemicitabine（1250mg／m2, d1, d8） was used in other 30 patients（control group） every 3 weeks for four cycles. The short-term effects, median progression-free survival, median overall survival and toxicity were compared between groups. Results In treatment group, intracranial metastases’effective rate and control rate，the total effective rate and disease control rate were 43.3% and 80.0％，40.0％ and 60.7％，while they were 13.3% and 46.7％，13.3％ and 30.0％ in control group with significant differences（P＜0.05）.In treatment group，median progression-free survival and median overall survival were 7.4 months and 12.8 months，while they were 4.2 months and 8.2 months in control group was statistically significant difference（P＜005）. The rates of nausea/vomiting and bone marrow suppression in treatment group were 533％ and 667％， while they were 33％ and 133％ with statistically significant difference（P＜0.05）. There was no significant difference in the incidence of diarrhea, fatigue and abnormac liver function（P＞0.05）. Conclusion Gefitinib treatment of elderly patients with NSCLC with brain metastases is effective and can improve the prognosis of patients，and the toxicity can be tolerated.