Chemotherapy for brain tumours
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.
Chemotherapy is not used to treat all brain tumours. It may be used for people with high-grade primary brain tumours, either as an initial treatment alongside radiotherapy, or where the tumour has come back. In this situation, chemotherapy is unlikely to be able to cure a brain tumour, but it can sometimes shrink a tumour down or slow its growth, which can reduce symptoms.
There are many different chemotherapy drugs. Not all of them can be used to treat brain tumours because they can’t cross the brain’s natural protection (called the blood-brain barrier). The main chemotherapy drugs used to treat primary brain tumours include:
Some are given as tablets or capsules, and some are given by injection into a vein (intravenously). Sometimes lomustine, procarbazine and vincristine are used together and this combination of chemotherapy drugs is known as PCV.
Another way of giving chemotherapy is by an implant that can be placed into the brain during an operation to remove or debulk the tumour. These implants (called Gliadel® implants) are small wafers or discs, which contain the chemotherapy drug carmustine. The surgeon will place up to eight wafers in the space where the tumour was. As the wafers dissolve, the drug is slowly released.
The type of chemotherapy you have will depend on the type and stage of the brain tumour. Chemotherapy to treat brain tumours can usually be given to you as an outpatient.
The National Institute for Health and Clinical Excellence (NICE) is an independent body that was set up by the government. NICE assesses medicines and treatments, and gives guidance to doctors on how they should be used in the NHS in England and Wales. The equivalent body in Scotland is the Scottish Medicines Consortium (SMC).
NICE currently recommends the use of carmustine (Gliadel) implants as a possible treatment for people with newly diagnosed high-grade glioma , if 90% or more of their tumour has been removed. The guidance states that people should have carmustine implants only at specialist treatment centres under the care of a team of experts.
NICE also recommends the use of temozolomide, along with radiotherapy, as a possible treatment for people with a type of high-grade glioma called a glioblastoma. People should be newly diagnosed, and fit and well enough to have it.
Carmustine implants and temozolomide have both been assessed by the SMC and have been approved for use in Scotland. Your doctor or specialist nurse can give you more information about them.
Side effects of chemotherapy
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Chemotherapy can cause side effects, which can be unpleasant, and for some people chemotherapy may have little effect on the tumour. This means that they will have the side effects without any noticeable benefits. The fitter a person is, the more likely they are to benefit from the chemotherapy and the less likely they are to have side effects.
Making decisions about treatment under these circumstances is always difficult. It will help to discuss with your doctors the possible benefits and side effects of chemotherapy in your situation. You can also talk to our cancer support specialists. You may also find it helpful to read our section on making treatment decisions.
Many people have few side effects and those that occur can often be well controlled with medicine. The main side effects are described here, together with some of the ways they can be reduced:
Lowered resistance to infection (neutropenia)
While the drugs are acting on the cancer cells in your body, they also temporarily reduce the number of normal white blood cells. When these cells are reduced, you’re more likely to get an infection and you may tire more easily. During chemotherapy your blood will be tested regularly and, if necessary, you may be given antibiotics to treat any infections.
You should contact your doctor or the hospital straight away if:
your temperature goes above 38˚C (100.4˚F)
you suddenly feel unwell, even with a normal temperature.
Anaemia (low number of red blood cells)
If the level of red blood cells in your blood is low you will become very tired and lethargic, and possibly breathless. These are symptoms of anaemia. If you become very anaemic, you may be given a blood transfusion.
Bruising and bleeding
The chemotherapy can reduce the production of platelets, which help the blood to clot. Having low numbers of platelets increases your chance of bleeding, and this can affect people in different ways. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood in your urine or stools, blood spots or rashes on the skin. You may need to have a platelet transfusion.
Feeling sick (nausea) and vomiting
Some chemotherapy drugs may make you feel sick (nauseated) and can also make you be sick (vomit). Your doctor can prescribe very effective anti-sickness drugs (anti-emetics) to prevent or greatly reduce nausea and vomiting.
If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet. Our diet and cancer section has some useful tips on coping with eating difficulties. We also have a section on controlling nausea and vomiting.
The chemotherapy drugs commonly used to treat brain tumours don’t usually cause hair loss but some may cause hair-thinning. If your hair does fall out while you’re having chemotherapy,
it should grow back over a period of 3-6 months. We have a section with tips on coping with hair loss.
Chemotherapy affects people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but many others find they become very tired and have to take things much more slowly. Just do as much as you feel like and try not to get too tired. We have a section about coping with fatigue.
Although all of these side effects may be difficult to cope with, most of them will gradually disappear once your treatment is over.
Watch other people's experiences of side effects
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Bengu talks about losing her hair when she had chemotherapy.
Denton explains how fatigue affected him after treatment for cancer.