Radiotherapy as a means of treating meningiomas.

Meningiomas are reasonably common benign intracranial tumours. Those treated surgically are not necessarily the same as those addressed by radiotherapy, in terms of patient factors and anatomical location. Using "lack of progression" as the criterion of benefit, in this population of 612 treated lesions (541 patients), the 10 year rate is 93% by any of the radiotherapy means used. Single fraction stereotactic radiosurgery (SRS) was used for smaller meningiomas, with fractionated radiotherapy for large volume tumours, and/or those in contact with the optic chiasm/nerve. Using median volume as the variable, larger tumours were as adequately controlled as smaller tumours. Symptomatic improvement was achieved in the majority of patients with worsened neurological deficit in <5% of patients. Subtotal resection followed by radiotherapy provides little advantage over radiotherapy alone. Local control is achieved in close to two-thirds of patients with Grade 2 or 3 meningiomas. More likely amongst the patients who have radiotherapy alone there will be patients with Grade 2 or 3 tumours (but are not biopsied) who have good long-term control. Surgery is very appropriate where complete resection (with low morbidity) can be achieved, and/or to decompress those tumours with pressure features. Informed consent can include a discussion regarding the role of radiotherapy.