Chemotherapy may be given:
- at the same time as radiotherapy
- after radiotherapy to make treatment more effective
- as your main treatment
- if a brain tumour comes back after surgery and radiotherapy.
Chemotherapy is usually the main treatment for a lymphoma that starts in the brain (Primary Central Nervous System Lymphoma).
Your doctor will tell you whether chemotherapy would be a useful treatment for you. The benefits of chemotherapy can depend on:
- the type, grade and biomarkers of a tumour
- your age and general health
- how effective other treatments have been.
Sometimes it is very clear that chemotherapy is likely to be effective in your situation. Or it may be clear that chemotherapy is not likely to help.
Sometimes the benefit of chemotherapy is not certain. If this is the case, your specialist doctor and nurse will talk to you about the possible advantages and disadvantages of chemotherapy in your situation.
It can be difficult to decide about having chemotherapy. Make sure you ask your doctor and nurse for all the information you need and take your time making your decision. We have more information about making treatment decisions that you may find helpful.
During chemotherapy, your doctor and nurse will check how you are and how well treatment is working. This means you can stop treatment if the disadvantages start to outweigh the benefits.
There are many chemotherapy drugs, but not all of them can be used to treat brain tumours. Doctors use drugs that can pass through the brain’s natural protection (called the blood-brain barrier) into the brain and spinal cord.
Different drugs are used in different situations. Your doctor will explain the drugs being used before you start treatment.
The main drugs used to treat primary brain tumours are:
- temozolomide (Temodal®)
- lomustine (CCNU), procarbazine and vincristine on their own or together (called PCV)
- carmustine (BCNU).
Other drugs may also be used – particularly for rarer types of brain tumours.
There are different ways of giving chemotherapy for brain tumours.
- Temozolomide, lomustine or procarbazine are capsules you swallow.
- Vincristine is a liquid that is given into a vein (intravenously).
- Carmustine is sometimes given as an implant called Gliadel wafers directly into the brain during surgery.
You usually take chemotherapy capsules yourself at home. Your doctor or nurse will tell you how and when to take them. You may be asked to take them for a certain number of days or weeks, with a rest period of a few weeks.
When you have chemotherapy given into a vein (intravenous chemotherapy), you will need to go to a chemotherapy day unit. A chemotherapy nurse will give it to you as one or more sessions of treatment. You usually have a rest period of a few weeks between each session.
The chemotherapy and the rest period is called a cycle of treatment. The length of a cycle depends on the chemotherapy drugs you are taking. Most cycles are 4 to 6 weeks long. Your doctor or nurse will explain what to expect.
Chemotherapy during surgery
During surgery, the surgeon puts small discs called Gliadel® implants or wafers into the area of the brain affected by the tumour. The discs contain the chemotherapy drug carmustine. They dissolve over 2 to 3 weeks and the drug is slowly released into the brain. You may have a course of radiotherapy treatment as well.
This type of chemotherapy causes slightly different side effects to capsules or intravenous chemotherapy. Some side effects are caused by the surgery itself. But a very small amount of carmustine will get into your blood. This can reduce the number of white blood cells in your blood and make you more likely to get an infection.
Chemotherapy with radiotherapy
Having both treatments causes more side effects, so you need to be physically well enough to cope. You also have more risk of getting a chest infection. To make this less likely, your doctor will prescribe antibiotics.
When you finish radiotherapy, you will also stop taking temozolomide for a time. You then start taking temozolomide again for up to 6 cycles. Your doctor or nurse will explain how often you need to take it.
We have more information about the side effects of chemotherapy.