When, where and how you have chemotherapy for a brain tumour, and the possible side effects.
What chemotherapy is
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
Chemotherapy can work well for some types of brain tumour. But it can be difficult to treat some brain tumours with chemotherapy drugs because the brain is protected by the blood brain barrier. This is a natural filter and only lets certain substances through from the blood to the brain tissues.
When you have chemotherapy
You might have chemotherapy:
- after surgery for some types of brain tumour, to try and stop it coming back
- with radiotherapy and for some months afterwards to increase survival
- if you have a brain tumour that has come back after treatment
How often you have chemotherapy
You might have some types of chemotherapy in cycles. You have the drugs for a few days every few weeks. There is a time with no treatment when you recover from the side effects. How often you have treatment will depend on the particular drug or drugs that you are having.
Types of chemotherapy
The most common type of drugs for brain tumours are:
- carmustine (BCNU)
- lomustine (CCNU)
Chemotherapy for children with brain tumours
Very young children (less than 3 years old) might have chemotherapy instead of radiotherapy if they have:
- a primitive neuroectodermal tumour (PNET)
- an ependymoma
- a glioma
This is to avoid radiotherapy when they are very young. They might have chemotherapy treatment for up to two years, and that's designed to reduce the long term side effects that radiotherapy can have in very young children.
Chemotherapy drugs they might have include:
- high dose methotrexate
Once the child is over 3 years old, they can have radiotherapy.
For some types of brain tumours in children, chemotherapy treatment can work very well. It is then possible to avoid giving radiotherapy after a year or more of chemotherapy treatment.
Your childs specialist will be able to discuss the best treatment options in your particular situation.
How you have chemotherapy
You might have chemotherapy as tablets, an injection into the vein (intravenous), or an injection into the spinal fluid (intrathecal). You might have chemotherapy as an implant (wafer).
Chemotherapy into the spinal fluid
You might have chemotherapy injected into the fluid around the brain and spinal cord (cerebrospinal fluid or CSF). This is called intrathecal chemotherapy.
The drug mixes with the spinal fluid and circulates throughout the brain.
You have the injection while having a lumbar puncture.
During surgery your treatment team might put a plastic dome under the skin of your scalp. It's called a ventricular access device or an Ommaya resevoir.
Your doctor or nurse gently puts a needle through your skin into the resevoir and your chemotherapy is given straight into the fluid filled spaces in your brain. So it goes straight into your cerebrospinal fluid (CSF).
Your surgeon might put chemotherapy drugs into the brain tissue as a wafer (implant). The chemotherapy drug itself is inside a gel wafer, which slowly dissolves over 2 or 3 weeks.
As it dissolves, the chemotherapy slowly releases into the brain tissue.
One example is a Gliadel wafer that contains carmustine (BCNU).
Into your bloodstream
You can have the chemotherapy through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.
Taking your tablets or capsules
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Never stop taking a cancer drug without talking to your specialist first.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take newspapers, books or electronic devices to help to pass the time.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- a lower resistance to infections
- bleeding and bruising easily
- diarrhoea or constipation
- hair loss
Side effects depend on:
- which drugs you have
- how much of each drug you have
- how you react
Tell your treatment team about any side effects that you have.
Most side effects only last for the few days that you’re having the chemotherapy drugs. Your treatment team can help to reduce your side effects.
When you go home
Chemotherapy for a brain tumour can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.
Dietary or herbal supplements
We don't yet know much scientifically about how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.
It is very important to tell your doctors if you take any supplements, or if you are prescribed them by alternative or complementary therapy practitioners.
Talk to your specialist about any other tablets or medicines you take while you are having active treatment.
Some studies seem to suggest that fish oil preparations might make some chemotherapy drugs work less well. If you take or are thinking of taking these supplements, talk to your doctor to find out whether they could affect your treatment.