About brain tumour chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells.

You may have chemotherapy

• After surgery, to try to prevent a brain tumour from coming back
• To treat brain tumours that have come back since they were first treated
• To shrink a brain tumour that cannot be operated on
• To shrink a tumour, or reduce its blood supply so that an operation is easier to do

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
• Oligodendroglioma
• Ependymoma
• 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 brain tumours with chemotherapy 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. This is a natural defence mechanism designed to keep harmful substances out of the brain. Only a few chemotherapy drugs can get across the blood-brain barrier.

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 seems severe, 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 tumours in children, it may be possible to avoid giving radiotherapy altogether after a year or more of chemotherapy treatment. This research is still experimental. We are not yet sure that this is a safe approach for all types of childhood brain tumour, so your child's specialist is in the best position to advise on the exact treatment.

You may have chemotherapy

• As a tablet
• Into a vein
• Into your spinal fluid (intrathecally)
• Into the area of a brain tumour

You have most chemotherapy drugs directly into your bloodstream, either as an injection into a vein or in a bag of fluid through a drip (IV). You swallow some drugs 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.

To allow you to recover from the side effects, you usually have chemotherapy for a few days every few weeks. How often you have treatment will depend on the drug or drugs that you are having.

Methotrexate is a chemotherapy drug that you can have injected into the fluid around the spinal cord to treat some brain tumours. This is known as intrathecal treatment, which can be shortened to IT. The drug mixes with the spinal fluid and circulates throughout the brain.

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 your brain tumour operation, the surgeon puts the wafers inside the brain, in 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 alone. The wafers are licensed for use in the UK for glioma brain tumours that have just been diagnosed or have come back since they were first treated. In June 2007, the National Institute for Health and Clinical Excellence (NICE) recommended carmustine wafers as a possible treatment for newly diagnosed high grade gliomas, if at least 90% of the tumour can be surgically removed.

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 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. 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 it works
• How chemotherapy is planned and given
• General side effects
• Living with chemotherapy. 

If you would like more information about chemotherapy, ask your chemotherapy nurse or contact our cancer information nurses. They would be happy to help.