The treatment you receive for a meningioma depends on many factors, including the size of your meningioma, where it's situated and how aggressive it's believed to be. Your doctor will also take into consideration your overall health and your goals for treatment.
Immediate treatment isn't necessary for everyone with a meningioma. A small, slow-growing meningioma that isn't causing signs or symptoms may not require treatment.
If the plan is not to undergo treatment for your meningioma, you'll likely have brain scans periodically to evaluate your meningioma and look for signs that it's growing.
If your doctor determines your meningioma is growing and needs to be treated, you have several treatment options.
If your meningioma causes signs and symptoms or shows signs that it's growing, your doctor may recommend surgery. Surgeons work to remove the meningioma completely. But because a meningioma may occur near many delicate structures in the brain or spinal cord, it isn't always possible to remove the entire tumor. In those cases, surgeons remove as much of the meningioma as possible.
The type of treatment, if any, you need after surgery depends on several factors.
- If no visible tumor remains, then no further treatment may be necessary. However, you will have periodic follow-up scans.
- If the tumor is benign and only a small piece remained, then your doctor may recommend periodic follow-up scans only. In some cases, small leftover tumors may be treated with a form of radiation treatment called stereotactic radiosurgery.
- If the tumor is atypical or malignant, you'll likely need radiation.
Surgery may pose risks including infection and bleeding. The specific risks of your surgery will depend on where your meningioma is located. For instance, surgery to remove a meningioma that occurs around the optic nerve can lead to vision loss. Ask your surgeon about the specific risks of your surgery.
If your meningioma can't be completely removed, your doctor may recommend radiation therapy following surgery. The goal of radiation therapy is to destroy any remaining meningioma cells and reduce the chance that your meningioma may recur. Radiation therapy uses a large machine to aim high-powered energy beams at the tumor cells.
Advances in radiation therapy increase the dose of radiation to the meningioma while reducing radiation to healthy tissue. These include fractionated stereotactic radiotherapy (SRT) and intensity-modulated radiation therapy (IMRT). Proton beam radiation may be an option, but whether this is superior to standard radiation is unclear.
Radiosurgery is a type of radiation treatment that aims several beams of powerful radiation at a precise point. Contrary to its name, radiosurgery doesn't involve scalpels or incisions. Radiosurgery typically is done in an outpatient setting in a few hours. Radiosurgery may be an option for people with meningiomas that can't be removed with conventional surgery or for meningiomas that recur despite treatment.
For tumors too large for radiosurgery or those in an area that can't tolerate the high intensity of radiosurgery — such as near the optic nerve — a possible option is fractionated radiation. This involves delivering the radiation in small fractions over time. For example, this approach might require one treatment a day for 30 days.
For people with meningiomas that recur or don't respond to surgery and radiation, doctors are trying different system treatments. Unfortunately, most chemotherapy has not proved valuable, but some drugs, such as hydroxyurea (Droxia, Hydrea), are sometimes used. Other drugs are being tested as well, such as those that prevent the release of growth hormones (somatostatin analogs). More recently, medications that inhibit the tumor's ability to recruit blood vessels (angiogenesis inhibitors) have shown some promise, but the data is preliminary. Much more study is needed.
May 02, 2014
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