Treatment

The treatment of meningioma depends on the size and location of the tumor, whether it is cancerous, whether the cancer has spread, and the patient’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials as a treatment option when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the clinical trials section.

People diagnosed with a CNS tumor generally need to seek treatment as soon as possible. The pressure caused by a growing CNS tumor can cause severe symptoms, including a backup of cerebrospinal fluid and problems with blood circulation, which can damage delicate nerves and deprive cells of nourishment.

Treating brain and spinal cord tumors can be difficult. The blood-brain barrier, which normally serves to protect the brain and spinal cord from damaging chemicals entering those structures, also keeps out many types of chemotherapeutic drugs. Meningioma grows outside the blood-brain barrier, so some drugs do reach these tumors; nonetheless, they are quite resistant to cure by currently available chemotherapeutic drugs. Surgery can be difficult if the tumor is near a delicate portion of the brain or spinal cord. Radiation therapy can damage healthy tissue. However, research in the past two decades has improved the survival rates of patients with CNS tumors. More refined surgeries, a better understanding of what types of tumors respond to chemotherapy, and precise delivery of radiation therapy have resulted in a longer life span and better quality of life for patients with CNS tumors, including meningiomas.

Surgery

Surgery is the most common type of treatment for meningioma and is often the only treatment needed. There have been rapid advances in surgery for CNS tumors, including the use of cortical mapping (a technique that records the functions of a specific part of the brain by placing electrodes directly on the surface of the brain) and enhanced imaging devices to give surgeons both anatomical and functional information, which helps them plan and perform the surgery and make it safer.

Surgery to the brain requires the removal of part of the skull, a procedure called a craniotomy. After the surgeon 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 provide a tissue samples for a biopsy analysis. The results of the analysis can show if additional treatments, such as radiation therapy, will be necessary.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Doctors may recommend radiation therapy along with surgery to slow the growth of aggressive tumors. Radiation therapy can be given in several ways. External-beam radiation therapy techniques use a machine outside the body to target the tumor. These techniques are becoming increasingly more precise. External-beam radiation may be used for meningioma.

Internal radiation therapy, or brachytherapy, involves tiny pellets or rods containing radioactive materials that are surgically implanted in or near the tumor site. However, this approach is and generally not used for meningioma except in clinical trials.

The following radiation therapy techniques may be used:

Conventional radiation therapy. The treatment area is set up based on anatomic landmarks and x-rays. In certain situations, such as whole brain radiation therapy for brain tumors, this technique is appropriate. For more precise targeting, more elaborate techniques are required. Chemotherapy may be used in combination with radiation therapy.

Three-dimensional conformal radiation therapy. Based on images from CT scans and MRI scans, a three-dimensional model of the tumor and normal tissues is created on a computer. Beam size and angles are determined in a way that maximizes the dose of radiation to the tumor, while reducing the amount of radiation exposure to normal tissue.

Stereotactic radiosurgery. In stereotactic radiosurgery, a computer assembles images from CT scans, MRI scans, or both, to locate the tumor and help direct the radiation beam. It involves delivering a single, high dose of radiation directly to the tumor and not healthy tissues. It works best for a tumor that is only in one area of the brain and for benign tumors (including most meningiomas). There are three methods by which stereotactic radiosurgery is performed:

• A modified linear accelerator is a machine that creates high-energy radiation by using electricity to form a stream of fast-moving subatomic particles, which can then be focused onto a tumor target.
  
  
• A gamma knife is another form of radiation therapy that concentrates highly focused beams of radioactivity on the tumor. A gamma knife can only be used for meningioma in the brain, not meningioma on the spine.
  
  
• A cyber knife is a device used in radiation therapy to guide radiation to the tumor target—particularly targets in the brain, head, and neck regions.

Fractionated stereotactic radiation therapy. Radiation therapy is delivered with stereotactic precision, but divided into small, daily fractions over several weeks using a relocatable head frame, in contrast to the one-day radiosurgery. This technique is best for tumors located close to complex or sensitive structures, such as the optic nerves or brain stem.

Intensity modulated radiation therapy (IMRT). Radiation therapy is delivered with greater intensity or dose to thicker areas of the tumor and with less intensity to thinner areas of the tumor. This is accomplished by placing tiny metal leaves in the path of the beam to reduce the intensity of the beam and to customize the shape of the dose to the shape of the tumor.

All of these more elaborate techniques are designed to achieve greater precision and reduce the dose to the surrounding normal tissue. Depending on the size and location of the tumor, the radiation oncologist may choose any of the above radiation therapy techniques. In certain situations, a combination of two or more techniques is appropriate.

Radiation therapy is usually not recommended for children younger than five because of potential danger to their developing brains.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor’s growth, or reduce symptoms. However, chemotherapy is rarely used in the current treatment of meningioma, although current research is investigating this form of treatment. The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net’s Drug Information Resources, which provides links to searchable drug databases.

Recurrent meningioma

Sometimes, despite initial treatment, the meningioma may not go into remission (the temporary or permanent disappearance of a tumor) or it recurs (comes back after treatment). The most common treatment for recurrent meningioma is additional surgery. If surgery cannot be performed, 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 since the symptoms of meningioma can interfere with quality of life.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: During Treatment.