Is there a difference in outcome between single fraction and multi-fraction SRS for meningioma? This systematic review and meta-analysis identified 1483 patients from 20 reports who received primary radiation with either single fraction (88%) or multi-fraction (12%) SRS. Most single fraction treatment sites were cavernous sinus (21.5%), tentorium (19.7%), or petroclival (18.7%) while most of the multi-fraction sites were sellar or parasellar (82.9%). As might be expected, tumor volume was almost 4 times higher in the multi-fraction arm (23.8cc v 6.1cc). The median marginal dose with single fraction was 14.9 Gy, and the median prescription isodose line was 61%. In the multi-fraction arm, median number of fractions was 4, median marginal dose was 23 Gy, and median prescription isodose line was 79.4%. Despite these differences, the rate of tumor control at 5 years was similar between techniques (94% v 93%). The rate of complications was also similar (10.4% v 11.4%). | Bin-Alamer, J Neurooncol 2023
