Chemotherapy for brain tumours
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy brain tumour cells. The drugs circulate throughout your body in the bloodstream.
You might have chemotherapy after surgery or if your brain tumour comes back. Common chemotherapy drugs for brain tumours are a drug called temozolomide. And a combination of drugs called procarbazine, lomustine and vincristine (PCV).
It can be difficult to treat brain tumours with some chemotherapy drugs because the brain is protected by the blood brain barrier. This is a natural filter between the blood and the brain which protects the brain from harmful substances.
When you have chemotherapy
You might have chemotherapy:
- after surgery for some types of brain tumour such as gliomas
- with radiotherapy and for some months afterwards
- for a brain tumour that has come back after treatment
Types of chemotherapy
Common types of chemotherapy drugs for brain tumours include:
- carmustine (BCNU)
- lomustine (CCNU)
- a combination of drugs called PCV (procarbazine, lomustine and vincristine)
The type of chemotherapy you have depends on which type of brain tumour you have. You might have other chemotherapy drugs if you have a less common type of brain tumour. You might have:
- methotrexate if you have lymphoma of the brain or CNS
- cisplatin or carboplatin if you have a germ cell tumour
How often you have chemotherapy
You usually have chemotherapy in cycles of treatment. This means that 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 depends on the particular drug or drugs that you are having.
How you have chemotherapy
There are different ways of having chemotherapy for a brain or spinal cord tumour.
You might have it:
- as a drip into your bloodstream (intravenously)
- into your spine (intrathecal chemotherapy)
- directly into your brain
- as tablets or capsules that you swallow (oral chemotherapy)
Chemotherapy as a drip into your bloodstream (intravenously)
You have treatment 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.
Chemotherapy into your brain
Chemotherapy implants (wafers)
Your surgeon might put chemotherapy drugs into the brain tissue as a wafer. The chemotherapy drug is inside a gel wafer, which slowly dissolves over 2 to 3 weeks.
As the gel wafer dissolves, the chemotherapy is slowly released into the brain tissue. One example is a Gliadel wafer that contains carmustine (BCNU).
During surgery, your treatment team might put a small plastic dome under the skin of your scalp. It's called a ventricular access device or an Ommaya reservoir. This is less common than chemotherapy wafers.
Your doctor or nurse gently puts a small needle through your skin into the reservoir. They then give the chemotherapy straight into the fluid filled spaces in your brain. So it goes straight into your cerebrospinal fluid (CSF). This bypasses the blood brain barrier, which means that doctors can give smaller doses of chemotherapy.
Chemotherapy as 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.
Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.
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 can usually bring a friend or family member with you.
Clare (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 on 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.
For some types of chemotherapy, or if you have chemotherapy into your brain or spinal cord, you usually 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 usually have these the day before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
The side effects vary from one person to another. It is difficult to predict how you will feel and what side effects you will have.
Common side effects of chemotherapy include feeling sick and a drop in the levels of white blood cells causing an increased risk of infection.
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.