How treatment decision are made
Treatment DecisionTreatment decisions for meningioma depend on several factors and are thoroughly discussed with your care team. As the majority of meningiomas are small and slow-growing, they are often monitored with periodic imaging tests rather than requiring immediate treatment.
- Size & Location: The size and location of the tumor plays a crucial role in shaping treatment decisions. Large tumors or tumors pressing on nearby brain or spinal structures are more likely to require immediate treatment. Location also affects whether surgery can be performed safely.
- Symptoms: The presence and severity of symptoms informs treatment decisions. Benign meningiomas often do not cause any symptoms and may remain undetected. However, meningiomas causing seizures or memory loss would likely require immediate treatment.
- Growth Rate: Most meningiomas grow slowly. Those that show rapid growth are likely to require immediate treatment rather than monitoring.
- Grade: Meningiomas are graded on a scale of 1-3. Grade 2 (atypical) and Grade 3 (anaplastic/malignant) meningiomas are likely to require treatment. They are also more likely to recur after treatment.
- Patient Health: The overall health of the patient is always considered when developing treatment plans. This includes age; younger people with meningioma are more likely to undergo surgery, for example.
- Preferences: Your care team is here to provide expert diagnosis, treatment, and guidance, but your individual preferences and goals are at the center of all treatment decisions.
How is Meningioma Treated?
TreatmentContinuous observation
If the meningioma is small and slow-growing, a “wait-and-see” approach may be recommended, especially if you aren’t experiencing any symptoms. Your doctor may suggest routine MRIs and check-ups to monitor the growth of the tumor and any other health issues that arise.
Surgery
The goal of surgical resection (removal of a tumor) is to remove as much of the meningioma as possible without causing harm to the surrounding areas and to relieve pressure on the brain, spinal cord, or nearby nerves that may be causing symptoms. For grade 2 and grade 3 meningiomas, surgery may be paired with radiation to arrest tumor growth.
Radiation therapy
Radiation therapy uses radiation beams to target a meningioma while minimizing damage to nearby cells. It can be helpful for tumors that are difficult to remove with surgery or are at higher risk of recurrence.
Radiation may be given as stereotactic radiosurgery, which delivers a very high dose in one or a few sessions, or as conventional fractionated radiation therapy, which delivers smaller doses over multiple treatments. Radiosurgery is often used for small, well-defined tumors, while conventional fractionated radiation may be preferred for larger tumors or tumors close to structures like the optic nerves, where spreading treatment out can help reduce risk.
Systemic Therapy
Systemic therapy (e.g. chemotherapy) targets tumor cells throughout the entire body. There are currently no approved systemic agents for treatment of meningioma, but research is ongoing to develop new and effective treatments.
Clinical Trials
Some patients may enroll in clinical trials, especially when standard treatment options are not effective. Clinical trials are research studies that give patients access to emerging procedures, therapies, and drugs. Clinical trials are entirely voluntary.
After Treatment
After TreatmentWhile meningioma often responds well to treatment, there is a chance the tumor will return. This is particularly the case for grade 2 and grade 3 meningiomas. For this reason, follow-up care is a crucial part of your treatment plan.
Follow Up
After treatment, your doctors will develop a follow-up plan based on your specific diagnosis and goals. Follow-up schedules vary and can evolve over time; some patients require check-ins every one or two years, while others require frequent screenings.
At these appointments, your doctor will typically run imaging tests, such as MRIs or CT scans, to determine if the tumor has returned. They will also check for neurologic symptoms.
It is important to contact your care team immediately should you develop new or worsening symptoms.
Recurrence
The likelihood of meningioma returning depends largely on its grade. Recurrence risk is generally higher in Grade 2 (atypical) and Grade 3 (anaplastic) meningiomas, as they are composed of rapidly dividing and aggressive cells. Most meningiomas are Grade I (benign) and less likely to recur after treatment.
Follow-up plans are carefully designed to catch changes early and ensure prompt treatment when necessary.
Living with Meningioma
Some people live with meningioma for years, as the majority of meningiomas are grade 1 and thus slow-growing. In these cases, your doctor will likely recommend a “wait and see” approach, with regular check-ins and imaging to monitor the tumor and check for symptoms.
Questions to ask at your appointment
- Grade: What grade is the tumor? Is it benign, atypical, or malignant?
- Size & Location: How big is the tumor and where is the tumor located? Is it pressing on any part of the brain or on any of the nerves?
- Treatment vs Monitoring: Do you recommend treatment or monitoring right now?
- Treatment: What type(s) of treatment do you recommend?
- Risks: What are the risks of treatment? Am I healthy enough to undergo treatment? What are the side effects and how are they managed?
- Recurrence: Can you tell me the likelihood of recurrence?
- Care Plan: What will my care plan look like? What symptoms/changes should prompt me to contact you between visits?
- Clinical Trials: Can I participate in a clinical trial? What are the benefits and risks of participation?
- Additional Support: What resources for support (financial, mental health, etc.) are available during treatment?
FAQs
This content has been reviewed by the following medical editors.
Trust NewYork-Presbyterian for Meningioma Treatment
At NewYork-Presbyterian, we treat the whole patient, not just the meningioma. Our teams of neurosurgeons, neuro-oncologists, radiation oncologists, and other specialists will work together to address your symptoms and provide the best treatment plan for you.
To learn more about our treatment options for meningioma, contact the cancer specialists at NewYork-Presbyterian for an appointment.