Radiotherapy for benign brain tumours coming of age; example of vestibular schwannoma

Abstract

Radiotherapy for benign intracranial tumours has been in use for decades with reasonably convincing evidence of efficacy, albeit in the absence of randomised trials comparing radiotherapy with other treatment modalities, particularly surgery. The principal measure of effectiveness in tumours with such an indolent natural history has been and remains tumour control and some measure of brain function. This usually describes functional benefit and what is assumed to be treatment related toxicity, although this is frequently difficult to disentangle from the direct tumour effect such as hearing loss following treatment of vestibular schwannoma (acoustic neuroma – AN) or visual impairment following irradiation of optic glioma. Benign intracranial tumours effectively treated with radiation include pituitary adenoma, meningioma, acoustic neuroma, pilocytic astrocytoma (particularly in its guise as optic glioma) and craniopharyngioma, though some may argue the natural history of craniopharyngioma does not sit well in the benign tumour category. The most extensive experience comes from decades of treatment of pituitary adenoma. Long-term results have highlighted the need to focus not only on direct tumour, treatment and disease related endpoints but also on survival, which may be affected by both the disease and the treatment [1,2]. This issue of the green journal includes reports of large cohorts of patients with benign intracranial tumours treated with stereotactic radiotherapy and radiosurgery to get us nearer the true long term outcome of current radiation techniques [3–5].