Current status of radiation therapy and radiosurgery in the treatment of intracranial meningiomas

Complete surgical removal, including resection of involved bone and dura, is curative of intracranial meningiomas in approximately 90% of cases. However, complete removal may entail unwarranted risk if the tumor involves or is adjacent to critical vascular or neural structures. In addition, it is possible for fragments of tumor to "evade" resection, even with the use of meticulous microsurgical technique. Because of this, clinicians may be faced with the decision of whether to offer or recommend radiation therapy or radiosurgery to a patient with a residual or recurrent meningioma. For many years, it has been recommended that external-beam radiation therapy be considered in the treatment of incompletely resected or malignant meningiomas. More recently, the role of radiosurgery as adjuvant or even primary therapy for meningiomas has attracted considerable attention. This article presents a review of the literature on postoperative radiotherapy of intracranial meningiomas.