ON THIS PAGE: You will learn about the different types of treatments doctors use for people with meningioma. Use the menu to see other pages.
This section explains the types of treatments that are the standard of care for meningioma. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.
Different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For meningioma, this team may include neuro-oncologists, medical oncologists, radiation oncologists, and surgeons. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.
Meningioma is typically a slow-growing tumor. However, because a growing CNS tumor can cause severe symptoms, people diagnosed with a CNS tumor should seek treatment as soon as possible. The pressure caused by a growing CNS tumor can cause serious symptoms that can damage delicate nerves and block cells from getting important nutrients.
Descriptions of the common types of treatments used for meningioma are listed below, including surgery, radiation therapy, and very rarely, chemotherapy. Your care plan also includes treatment for symptoms and side effects, an important part of care for meningioma.
Treatment options and recommendations depend on several factors, including the type and grade of the tumor, possible side effects, and the patient’s preferences and overall health.
Treating brain and spinal cord tumors can be challenging. Surgery is the most common type of treatment, but it can be difficult if the tumor is near a delicate part of the brain or spinal cord. The blood-brain barrier, which normally protects the brain and spinal cord from damaging chemicals, also keeps out many types of chemotherapy. Meningioma grows outside the blood-brain barrier, so some drugs can reach these tumors. However, current chemotherapy options do not work very well for meningioma.
With continued research, more refined surgeries, a better understanding of the tumors that can be treated with chemotherapy, and precise delivery of radiation therapy have helped more patients with CNS tumors live longer and have a better quality of life.
Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for meningioma because there are different treatment options.
Learn more about making treatment decisions.
Because a grade I meningioma grows slowly, active surveillance may be recommended for some patients. This approach is also called watchful waiting or watch-and-wait. During active surveillance, the tumor is monitored and treatment would begin if it started causing any symptoms or problems. This approach may be used for much older patients or for those with a tumor that was discovered accidentally and is not causing any symptoms. Often, patients continue to see their neurosurgeon for ongoing monitoring for a grade I meningioma.
Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. For meningioma, it is the most common treatment. And it is often the only treatment needed for a person with a noncancerous tumor that can be completely removed during surgery. For patients with a cancerous tumor or a tumor that cannot be fully removed during surgery, the treatment plan often includes radiation therapy and/or chemotherapy after surgery (see below).
Blocking the blood vessels that feed the tumor may be performed before surgery to reduce bleeding. Surgery to the brain is done by removing part of the skull, a procedure called a craniotomy. A neurosurgeon is a doctor who specializes in surgery of the brain and spinal cord. After the neurosurgeon removes the tumor, the patient’s own bone will be used to cover the opening in the skull.
In addition to removing or reducing the meningioma, surgery can be used to take a tumor sample for analysis under a microscope by a pathologist or neuropathologist (see Diagnosis). A neuropathologist is a doctor who specializes in the diagnosis of diseases of the nervous system by studying tissue under a microscope. The results of the analysis can show if additional treatments, such as radiation therapy, will be necessary.
There have been rapid advances in surgery for brain tumors, including cortical mapping to identify the areas of the brain that control the senses, language, and motor skills and enhanced imaging methods to give surgeons more tools to plan and perform the surgery. Talk with your doctors to learn about the specific techniques that your surgery will include, including the possible side effects and what you can expect during your recovery.
Learn more about the basics of surgery.
Radiation therapy is the use of high-energy x-rays or other particles to destroy tumor cells. A doctor who specializes in giving radiation therapy to treat a tumor is called a radiation oncologist. Doctors may recommend radiation therapy along with surgery to slow the growth of an aggressive tumor. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. Radiation therapy can be given in several ways.
Internal radiation therapy or brachytherapy is the use of tiny pellets or rods containing radioactive materials that are surgically implanted in or near the tumor. This approach is very rarely used for meningioma.
External-beam radiation therapy techniques use a machine outside the body to target the tumor. These techniques are becoming better able to direct radiation to the tumor while avoiding healthy tissue. For example, a linear accelerator is a special x-ray machine that moves around the body to direct pencil-thin beams of radiation to the brain tumor at different angles and intensities. This helps reduce the amount of healthy tissue exposed to radiation.
The following external-beam radiation therapy techniques may be used for meningioma:
Conventional radiation therapy. In this procedure, the direction of radiation is determined by features of the brain and skull and by x-rays. When a person’s entire brain needs to receive radiation therapy, this technique is appropriate. For more precise targeting, different techniques are needed.
Intensity modulated radiation therapy (IMRT). IMRT is a type of external-beam radiation therapy that can more directly target a tumor, further sparing healthy tissue from radiation therapy. In IMRT, the radiation beams are broken up into smaller beams and the intensity of each of these smaller beams can be changed. This means that the beams giving more radiation can be directed only at the tumor. It is most useful to treat a tumor that is near critical parts of the brain, such as the brain stem and areas that control eyesight.
3-dimensional conformal radiation therapy. Based on CT and MRI images, a 3-dimensional model of the tumor and healthy tissues is created on a computer. Beam size and angles are determined that deliver more radiation to the tumor and less to the healthy tissue.
Stereotactic radiosurgery. Stereotactic radiosurgery delivers a single, high dose of radiation therapy directly to the tumor and not healthy tissue. It works best for a tumor that is only in 1 area of the brain and some benign tumors, including most meningiomas. There are many different types of stereotactic radiosurgery equipment, including:
A modified linear accelerator, which is a machine that creates high-energy radiation by using electricity to form a stream of fast-moving particles that help kill tumor cells.
Gamma Knife is another form of radiation therapy that concentrates highly focused beams of gamma radiation on the tumor. A Gamma Knife can only be used for meningioma in the brain, not meningioma on the spine.
CyberKnife is a robotic device used in radiation therapy to guide the radiation to the tumor. It is most often used for tumors in the brain, head, and neck.
Fractionated stereotactic radiation therapy. Fractionated stereotactic radiation therapy is similar to stereotactic radiation therapy, except that it uses smaller, daily doses given over several days to several weeks. Precise positioning of the patient is very important, and a special head frame is used to target the radiation. This technique is best for tumors close to complex or sensitive structures, such as the optic (eye) nerves or brain stem.
Proton radiation therapy. Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy tumor cells.
With these different techniques, doctors are trying to better target only the tumor and reduce the dose to the surrounding healthy tissue. Depending on the size and location of the meningioma, the radiation oncologist may choose any of the above radiation therapy techniques.
Learn more about the basics of radiation therapy.
Side effects of radiation therapy
Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and neurologic symptoms. Most side effects go away soon after treatment is finished. Also, radiation therapy is usually not recommended for children younger than 5 because of the high risk of damaging their developing brains.
There are possible long-term side effects that may occur years after treatment. A person may experience cognitive problems, including memory loss and a slow decline in intellectual performance.
If the pituitary gland received radiation, there may be changes in hormonal levels. The pituitary gland is a small gland near the brain that releases hormones that control bodily functions. In these situations, patients should be evaluated by an endocrinologist. An endocrinologist is a doctor who specializes in hormones, glands, and the endocrine system of the body.
How severe these side effects are depends on how much radiation therapy was given and where in the brain it was used. These side effects have become less severe with better technology and precision in radiation therapy. Talk with your radiation therapist before treatment begins if you have any questions or concerns about the possible long-term side effects of radiation therapy.
Chemotherapy is the use of drugs to destroy tumor cells, usually by keeping the tumor cells from growing, dividing, and making more cells. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating a tumor with medication, or a neuro-oncologist. As explained above, chemotherapy is rarely used to treat meningioma.
The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.
Learn more about the basics of chemotherapy.
Physical, emotional, and social effects
Meningioma and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the tumor.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of tumor, may receive this type of care. And it often works best when it is started right after a diagnosis. People who receive palliative care along with treatment for the tumor often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the tumor, such as chemotherapy, surgery, or radiation therapy. Common types of palliative care for people with a brain tumor include:
Steroids. Steroids occur naturally in the body in tiny amounts. In larger amounts, they are very powerful anti-inflammatories that reduce swelling. Most people with a brain tumor will need steroids to help relieve swelling of the brain. You will most likely receive steroids when you are first diagnosed, before and after surgery, before and after radiation therapy, and if you have an advanced brain tumor. Steroids may cause weight gain and water retention, increased appetite, difficulty sleeping, changes in mood, and stomach irritation. After successful treatment for the brain tumor, your doctor may slowly reduce the amount of steroids you need to take over time.
Anti-seizure medication. A person with a CNS tumor may experience seizures (see Symptoms and Signs). This type of medication helps to control how often a person has seizures.
Shunt. If fluid begins to build up in the brain, a surgeon may need to place a device called a shunt to bypass or move the fluid or drain the excess fluid.
Antidepressant medication. Depression can be common in people with a CNS tumor, but it is often undiagnosed. However, not all people with a CNS tumor are depressed. Let your health care team know how you are feeling on a regular basis. For those who have symptoms of depression, the health care team may decide to prescribe an antidepressant medication to help with your symptoms. Learn more about depression.
Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.
During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
Remission and chance of recurrence
A remission is when the tumor cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the tumor will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the tumor returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the tumor does return. Learn more about coping with the fear of recurrence.
If the tumor returns after the original treatment, it is called a recurrent tumor. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, radiation therapy, and chemotherapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent tumor. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
The most common treatment for recurrent meningioma is additional surgery. If surgery cannot be done, radiation therapy is generally used. In addition, a patient can still receive care to manage the symptoms caused by the tumor. Symptom management is always important because the symptoms of meningioma can interfere with a person’s quality of life.
People with a recurrent tumor often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with a recurrence.
If treatment does not work
Recovery from meningioma is not always possible. If the tumor cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for many people, advanced meningioma is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced disease and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with meningioma. Use the menu to choose a different section to read in this guide.