About brain tumour chemotherapy
This page tells you about chemotherapy for brain tumours. There is information about
- A quick guide to what's on this page
- What chemotherapy is
- Chemotherapy for brain cancer
- The blood brain barrier
- Chemotherapy for children with brain tumours
- How you have chemotherapy
Chemotherapy for brain tumours
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. For some types of brain tumour you may have chemotherapy after surgery, to try to prevent the tumour from coming back. Chemotherapy is sometimes given with radiotherapy and for some months afterwards to help people to live longer. It may also treat a brain tumour that has come back since it was first treated.
Chemotherapy works very well for some types of brain tumour but it does not work for all of them. You may have some types of chemotherapy in cycles. You have the drugs for a few days every few weeks. Then there is a time with no treatment to allow you to recover from the side effects. How often you have treatment will depend on the particular drug or drugs that you are having.
Tablets, capsules and drugs into a vein
Some chemotherapy drugs are given as tablets or capsules that you swallow. You have some drugs as injections into the bloodstream through a tube put into a vein.
Chemotherapy into the fluid around the brain
It is possible to inject some drugs into the fluid that circulates around the brain and spinal cord (the cerebrospinal fluid) during a lumbar puncture. Doctors call this intrathecal treatment. Or sometimes during surgery your surgeon may put a plastic, dome shaped device under the skin of the scalp. It is called a ventricular access device or an Ommaya reservoir and has thin tubing on the lower surface that goes into the fluid filled spaces (ventricles) of the brain. Your doctor can give chemotherapy treatment into the CSF using the reservoir.
Chemotherapy into the brain
Some brain tumour chemotherapy drugs may be put into the brain tissue during surgery. The chemotherapy drug is fixed inside a gel wafer. At the end of the operation, the surgeon puts the wafers inside the brain, into the area of the tumour. Over 2 or 3 weeks the gel dissolves. As it does so, it slowly releases the chemotherapy drug directly into the brain tissue.
Chemotherapy in children with brain tumours
Children younger than 3 years old may have chemotherapy instead of radiotherapy for some types of tumour. Your child will have chemotherapy for up to 2 years. Once the child is over 3, they usually have radiotherapy.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells.
You may have chemotherapy for any of the following situations.
- After surgery for some types of brain tumour, to try to prevent it from coming back
- With radiotherapy and for some months afterwards to increase survival
- To treat a brain tumour that has come back since it was first treated
Chemotherapy does not work for every type of brain tumour. So specialists don't suggest it for every type. You are most likely to have chemotherapy for
- High grade glioma
- Gliomas in children
- High grade meningioma that has come back
- Primitive neuroectodermal tumours (PNETs) in children
- Primitive neuroectodermal tumour that has come back
- Germinomas of the pineal gland
- Other pineal region tumours
- Spinal tumours in children
- Primary lymphoma of the central nervous system
- A secondary brain tumour that has spread to the brain from cancer somewhere else in the body
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 within the body. It only allows certain substances through from the blood to the brain tissues. Some drugs can cross the blood brain barrier. Some brain tumours damage the blood brain barrier so that the chemotherapy can enter the brain.
Chemotherapy can be given as tablets or capsules or as injections into a vein. It is possible to inject some drugs into the fluid that circulates around the brain and spinal cord. Doctors call this intrathecal treatment.
Very young children (less than 3 years old) with primitive neuroectodermal tumours (PNETs), ependymomas or gliomas may have chemotherapy instead of radiotherapy. This is so that they don't have to have radiotherapy when they are very young. Your child will have the same chemotherapy drugs repeated every few weeks for up to 2 years. This treatment may seem intense but it is designed to reduce the long term side effects that radiotherapy can have in very young children. Once the child is over 3 years old, they can have radiotherapy.
For some types of brain tumour in children, chemotherapy treatment can work very well. It is then possible to avoid giving radiotherapy altogether after a year or more of chemotherapy treatment. Your child's specialist is in the best position to advise on the best treatment.
You have most chemotherapy drugs for brain tumours directly into your bloodstream, either as an injection into a vein or in a bag of fluid through a drip (IV). You may have the drugs through a small tube called a cannula put into a vein in your hand or arm. Or you may have the drugs through a long tube called a central line that goes onto a large vein in the chest.
You often have the chemotherapy in cycles. You have the drugs for a few days every few weeks. Then there is a time with no treatment to allow you to recover from the side effects. How often you have treatment will depend on the particular drug or drugs that you are having.
Some drugs for brain tumours are swallowed as tablets or capsules, for example temozolomide, procarbazine or lomustine (CCNU). The advantage of tablets or capsules is that you can have most or all of your treatment at home as an outpatient. But you may have treatment with a combination of several drugs, some of which are tablets and some given as injections or through drips.
How often you have treatment, and how long you have it for, will depend on the drug or drugs that you are having.
Some drugs, such as methotrexate, can be injected into the fluid around the spinal cord (the cerebrospinal fluid or CSF). This can help to treat some types of brain tumour. The injection is done during a lumbar puncture and is known as intrathecal treatment. This term is often shortened to IT chemotherapy. The drug mixes with the spinal fluid and circulates throughout the brain.
Sometimes during surgery your treatment team may put in a plastic, dome shaped device under the skin of the scalp. It is called a ventricular access device or an Ommaya reservoir. The device has thin tubing on the lower surface that goes into the fluid filled spaces (ventricles) of the brain. By putting a needle through your skin and into the reservoir your doctor can give chemotherapy treatment into the CSF.
Some brain tumour chemotherapy drugs may be put into the brain tissue as a wafer (implant). The chemotherapy drug is fixed inside a gel wafer. At the end of a brain tumour operation, the surgeon puts the wafers inside the brain, into the area of the tumour. Over 2 or 3 weeks the gel dissolves. As it does so, it slowly releases the chemotherapy drug directly into the brain tissue.
One type of wafer is the Gliadel wafer. The wafer contains carmustine (BCNU). Gliadel wafers are mostly used to treat high grade gliomas. They can be implanted during surgery to remove or debulk the tumour. Clinical trials have shown that Gliadel wafers can lengthen survival time for some people and may help to control symptoms of high grade gliomas for longer than surgery and radiotherapy on their own.
We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed any remedies by alternative or complementary therapy practitioners.
Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section.
Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking, or thinking of taking, these supplements talk to your doctor to find out whether they could affect your treatment.
For more about chemotherapy look at the main chemotherapy section. It explains the treatment in detail including
- How chemotherapy works
- Planning chemotherapy
- How you have chemotherapy
- General side effects
- Life during chemotherapy
If you would like more information about chemotherapy for brain tumours, ask your chemotherapy nurse. You can contact the Cancer Research UK nurses on freephone 0808 800 4040. They would be happy to help. Lines are open from 9am to 5pm, Monday to Friday.
If you want to find people to share experiences with online, you could use CancerChat, our online forum.
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