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Chemotherapy treatment

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:

  • temozolamide
  • procabazine
  • carmustine (BCNU)
  • lomustine (CCNU)
  • vincristine

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:

  • cyclophosphamide
  • vincristine
  • cisplatin
  • etoposide
  • carboplatin
  • 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).

Chemotherapy wafers

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

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

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.

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.

Side effects

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
Contact your doctor or nurse immediately if you have any signs of infection such as a temperature higher than 38C or generally feeling unwell. Infections can make you very unwell very quickly.

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.

Clinical trials

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.

Last reviewed: 
22 Oct 2015
  • Guidelines on the diagnosis and management of primary CNS and intra-ocular lymphoma (PCNSL)

    British Neuro-Oncology Society, June 2011

  • Improving outcomes for people with brain and other CNS tumours

    National Institute for Health and Clinical Excellence, June 2006

  • Principles and practice of oncology (10th edition)
    VT De Vita, S Hellman and SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

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