Step by step stereotactic planning of meningioma: A guide to radiation oncologists—the ROSE case [radiation oncology from simulation to execution

Abstract

Background: Intracranial meningiomas account for 33% of all primary tumors of the brain. One of the main modalities of the treatment is stereotactic radiosurgery (SRS). Here, we describe the procedural steps for radiation planning of stereotactic radiotherapy (SRT) of meningioma. Methods: The step-by-step procedure for stereotactic planning of meningioma has been described using a clinical scenario of meningioma. Results: The stereotactic radiation planning of meningioma starts with the basic history and relevant clinical evaluation of various signs and symptoms of the patient followed by imaging and grading of meningioma. Magnetic resonance imaging (MRI) of the brain is the imaging modality of choice. Evaluation of surgical notes and postoperative histopathology confirmation of diagnosis should also be done. Radiation is indicated in postoperative residual or recurrent disease and in unresectable settings. The radiation planning of meningioma starts with computed tomography (CT) simulation and MRI of the brain that should be performed in prescribed format to achieve uniformity in radiation planning. After CT and MRI fusion, contouring of target, organs at risk (OAR), and radiation planning should be performed. The plan evaluation includes target and OAR coverage index, conformity, homogeneity and gradient index, and beam arrangement. After radiation plan evaluation, the treatment is delivered after quality assurance and dry run. Conclusion: The article highlights the sequential process of radiation planning for SRT of meningioma—starting from simulation to planning, evaluation of plan, and treatment.