Because of a substantial overall recurrence rate of meningiomas, the role of surgery as the sole treatment for every case must be evaluated. Also, occasionally, the patient's age and/or the location of the tumor precludes considering him/her as a candidate for surgery. In these instances, radiotherapy or radiosurgery may be advisable. The article presents two cases treated at M.D. Anderson Cancer Center, those of a 65-year-old male with a tumor in the left temporal lobe and 74-year-old female with a tumor in the right petroclival region. It also reviews the roles that radiotherapy plays in treating patients with meningiomas. Retrospective analyses of outcomes provide ample evidence that conventional radiation after incomplete resection reduces the incidence of progression of tumor over a long period. Information on patients who have had only external radiation is meager, since most patients have at least a partial resection. Complete resection for benign meningiomas is sufficient. For malignant meningiomas, adjuvant radiation should be administered, regardless of the extent of surgical excision. When surgery poses a high risk of morbidity or mortality, radiation therapy and radiosurgery are promising alternatives.
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