title: Radiotherapy and radiosurgery for benign skull base meningiomas.
abstract: Meningiomas located in the region of the base of skull are difficult to access. Complex combined surgical approaches are more likely to achieve complete tumor removal, but frequently at a cost of treatment related high morbidity. Local control following subtotal excision of benign meningiomas can be improved with conventional fractionated external beam radiation therapy with a reported 5-year progression-free survival up to 95%. New radiation techniques, including stereotactic radiosurgery (SRS), fractionated stereotactic radiotherapy (FSRT), and intensity-modulated radiotherapy (IMRT) have been developed as a more accurate technique of irradiation with more precise tumor localization, and consequently a reduction in the volume of normal brain irradiated to high radiation doses. SRS achieves a high tumour control rate in the range of 85-97% at 5 years, although it should be recommended only for tumors less than 3 cm away more than 3 mm from the optic pathway because of high risk of long-term neurological deficits. Fractionated RT delivered as FSRT, IMRT and protons is useful for larger and irregularly or complex-shaped skull base meningiomas close to critical structures not suitable for single-fraction SRS. The reported results indicate a high tumour control rate in the range of 85-100% at 5 years with a low risk of significant incidence of long-term toxicity. Because of the long natural history of benign meningiomas, larger series and longer follow-up are necessary to compare results and toxicity of different techniques.
authors.affiliation: Department of Radiotherapy Oncology, Sant' Andrea Hospital, University La Sapienza, Rome, Italy. gminniti@ospedalesantandrea.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Minniti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Amichetti
authors.forename: Riccardo Maurizi
authors.initials: RM
authors.lastname: Enrici
mesh_terms: D002986:Clinical Trials as Topic; D006801:Humans; D008579:Meningioma / Q000532:radiotherapy* / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods; D011878:Radiotherapy / Q000379:methods; D019292:Skull Base Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome