Recurrent, irresectable meningioma constitutes an uncommon but significant problem. Many systemic therapies have been tested without clear evidence of efficacy. More recently, two reports have suggested that hydroxyurea has activity in this context. This study examined the efficacy and toxicity of hydroxyurea in the treatment of 15 patients with high risk meningioma, residual meningioma post resection and progressive meningioma. Hydroxyurea was well tolerated although two patients ceased therapy because of skin rashes. There were no objective responses. Eleven patients achieved stable disease including eight patients who had documented progression prior to commencing hydroxyurea. These results are consistent with previous reports. In conclusion, hydroxyurea may provide some clinical benefit in patients with progressive meningioma by delaying progression of disease.