||BACKGROUND:: Fractionated Stereotactic Radiotherapy (FSRT) is a non-invasive treatment for acoustic neuromas (AN). Initial reports from our institution demonstrated that reduction of treatment dose to 46.8 Gy resulted in improved preservation of functional hearing status. OBJECTIVE:: We now report the tumor control (TC), symptomatic outcome, and hearing preservation rate (HP) in patients treated with reduced-dose FSRT. METHODS:: We analyzed all patients with AN treated from 2002 to 2011. All patients received 46.8 Gy in 1.8 Gy fractions. Follow-up audiogram and MRI were performed in = one-year intervals. TC and HP were calculated by the Kaplan-Meier method. Analysis of HP, defined as Gardner-Robertson value = 2, was determined by audiometric data. Non-hearing related symptoms were defined by Common Terminology Criteria for Adverse Events version 4. RESULTS:: In total, 154 patients were analyzed. At a median follow-up of 35 months (range 4-108) TC was achieved in 96% of patients (n=148/154) and at 3- and 5-years was 99% and 93%. Eighty-seven patients had serviceable hearing at time of FSRT and evaluable audiometric follow-up. Overall HP was 67% and at 3- and 5-years was 66% and 54%. Pure tone average decreased by a median of 13 decibels in all patients. Nineteen percent (n=31) of patients experienced symptom improvement and 8% (n=13) had worsening of symptoms. Cranial nerve dysfunction occurred in 3.8% of patients (n=6). CONCLUSION:: Reduced-dose FSRT to 46.8 Gy for AN achieves excellent functional HP rates and limited toxicity without compromising long-term TC. Based on these promising outcomes, further attempts at dose de-escalation may be warranted.