Radiotherapy For Skull Base Tumors

Skull base meningiomas present significant therapeutic challenges due to their deep location and proximity to critical neurovascular structures. Although surgical excision remains the primary treatment modality for accessible lesions, complete resection is often not feasible in skull base tumors, leading to higher rates of residual disease and recurrence. Radiotherapy (RT) has therefore emerged as a crucial component in both adjuvant and definitive management. Conventional fractionated external beam radiotherapy has demonstrated long-term tumor control rates exceeding 75–90% at 10 years following subtotal resection. Recent advances in radiation oncology—including stereotactic radiosurgery (SRS), fractionated stereotactic radiotherapy (FSRT), intensity-modulated radiotherapy (IMRT), and stereotactic body radiotherapy (SBRT)—enable highly conformal dose delivery with improved sparing of surrounding organs at risk. Published data indicate 5-year local control rates of 85–97% with stereotactic techniques and a low incidence of late toxicity. Treatment selection is guided by tumor size, proximity to critical structures such as the optic apparatus and brainstem, histological grade, and surgical accessibility. While SRS is best suited for small lesions, fractionated approaches are preferred for larger tumors or those adjacent to sensitive structures. Overall, radiotherapy—particularly with modern stereotactic techniques—offers effective, safe, and durable tumor control for skull base meningiomas, though long-term prospective studies are required to establish the optimal modality and fractionation strategies.