Fractionated radiotherapy for vestibular schwannoma

Radiotherapy (RT) has become an increasingly attractive treatment for vestibular schwannomas (VS) in the last 30 years. Fractionated radiotherapy (FRT) for VS typically involves delivering a dose of 2Gy or less daily over the course of several weeks. With increasing advances in linear accelerator technology, it is now possible to deliver FRT with a stereotactic setup (FSRT) to levels of precision previously only seen in patients receiving stereotactic radiosurgery (SRS) with treatments such as Gamma Knife. FRT can be used where patients cannot tolerate SRS, in situations where treatment-related edema might be a concern, and in patients where hearing preservation is paramount. This chapter outlines the delivery of FRT and FSRT together with outcomes and toxicities from fractionated RT treatment in VS.