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: 

• temozolomide
• procarbazine
• carmustine (BCNU)
• lomustine (CCNU)
• vincristine
• 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 (for example, chemotherapy wafers)
• 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).

This isn't a very common treatment. Ask your doctor or nurse if you want to know more about this treatment. 

Ommaya reservoir

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. 

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 a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test. 

Side effects

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.