Step-by-step stereotactic radiotherapy planning of vestibular schwannoma: A guide to radiation oncologists—the ROSE case (Radiation Oncology from Simulation to Execution)

Background: Vestibular schwannoma (VS) is a slow-growing tumor that represents 90% of all tumors at the cerebellopontine angle. One of the main modalities of the treatment is stereotactic radiotherapy (SRT). Here, we describe procedure details for stereotactic planning of VS. Methods: The step-by-step procedure for stereotactic planning of pituitary adenoma has been described using a clinical scenario of VS. Results: The stereotactic radiation planning of VS starts with the basic history and relevant evaluation of symptoms such as tinnitus, dizziness, and facial symptoms. Magnetic resonance imaging (MRI) of the brain is the imaging modality of choice. The radiation planning of VS 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, treatment is delivered after quality assurance and dry run. Conclusion: The article highlights the sequential process of radiation planning for SRT of VS—starting from simulation to planning, evaluation of plan, and treatment.