How do you approach conventionally fractionated radiotherapy for treatment of an acoustic neuroma?

With 12 Gy single-fraction radiosurgery producing excellent tumor control, low complication rate, and good hearing preservation, we have rarely been using conventional fractionated radiotherapy for acoustic neuroma. If one uses conventional fractionated radiotherapy, the PTV margins will depend on t...

50.4 Gy in 28 fractions is considered if the patient has serviceable hearing.

For acoustic neuroma/vestibular schwannoma, single fraction SRS is typically used with excellent local control, and good hearing preservation.

But in larger tumors, fractionated radiation therapy can be used. University of Heidelberg published on 57.6 Gy in 32 fractions (Combs et al., IJROBP 2005). T...

I used to favour fractionated radiation therapy to 45-50 Gy for acoustics with serviceable hearing based on some excellent articles from Thomas Jefferson, such as Champ C et al, Neurosurgery 2013. But then the single fraction radio surgery data came out with good hearing preservation rates with the ...