Fractionated radiotherapy for intracranial meningiomas

Fractionated external beam radiotherapy (EBRT) has multiple roles in the management of intracranial meningiomas. In multiple series post-operative EBRT has shown improved progression-free survival following subtotal resection and a reduction in long-term failures following an apparent gross total resection. In the definitive setting, the use of EBRT has increased as the growing utilization of neuro-imaging for various conditions identifies skull-based lesions which are not easily resectable. Optic nerve sheath meningiomas represent a classic example of the use of definitive EBRT, given the frequent visual sequelae of surgery or observation. EBRT planning is highly individualized and requires a detailed understanding of tumor grade, adjacent radiosensitive structures such as the anterior optic apparatus, and radiographic characteristics of the tumor such as hyperostosis.