Chemotherapy for primary brain tumours

Chemotherapy is a drug treatment that destroys cancer cells. You may have this with radiotherapy or after radiotherapy or other treatments. Sometimes your main treatment is chemotherapy.

The most common drugs used to treat primary brain tumours are:

  • temozolomide (Temodal®)
  • lomustine (CCNU), procarbazine and vincristine on their own or together (called PCV)
  • carmustine.

Some are given as tablets, others by injection into a vein (intravenously). Intravenous chemotherapy is given in a chemotherapy day unit. After treatment, there is a rest period of a few weeks before you have chemotherapy again. This is called a cycle of treatment.

Chemotherapy is also sometimes given directly into the brain during surgery to remove the tumour. This is called Gliadel® implants.

Side effects can depend on the drugs you have and whether they are given at the same time as surgery or radiotherapy.

What is chemotherapy?

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Cytotoxic means toxic to cells. These drugs affect the way cancer cells grow and divide, but they also affect normal cells.

Chemotherapy may be given:

  • at the same time as your radiotherapy
  • after radiotherapy to make treatment more effective
  • as your main treatment
  • if a brain tumour comes back after surgery and radiotherapy.

Information from research (clinical trials) helps doctors understand when chemotherapy is likely to be most effective. In some situations, it is still not yet clear how helpful chemotherapy is likely to be or when it should be given.

If this is the case, your doctor and nurse will explain. They will talk to you about the possible advantages and disadvantages of chemotherapy in your situation. Make sure you ask them for all the information you need and take your time making your decision. We have a booklet called Making treatment decisions that you may find helpful.

Chemotherapy is usually the main treatment for a lymphoma that starts in the brain (PCNSL).

The drugs

There are different 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.

The main drugs used to treat primary brain tumours are:

There are different ways of giving chemotherapy for brain tumours. You take temozolomide, lomustine or procarbazine by mouth as capsules. Vincristine is a liquid that is given into a vein (intravenously). Carmustine is given as an implant 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 number of days or weeks and then have a rest period of a few weeks.

To have 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 will then have a rest period of a few weeks.

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 four to six weeks long. Your doctor or nurse will explain more about this. How long chemotherapy continues depends on your individual situation. But most courses of chemotherapy are six cycles.

Chemotherapy given with radiotherapy

If you have a high-grade glioma, you may be treated with temozolomide and radiotherapy together. This means you take temozolomide capsules every day during your course of radiotherapy. The radiotherapy usually lasts for six weeks.

Having both treatments causes more side effects so you need to be physically well enough to cope with it. You also have more risk of getting a chest infection. To make this less likely, your cancer doctor will prescribe antibiotics for you to take.

When you finish radiotherapy, you will have a break. You then start taking temozolomide again for six cycles. Your doctor or nurse will explain how often you take it.

Chemotherapy given during surgery

Chemotherapy can also be given as a single treatment directly into the brain. This is sometimes used for people having surgery to remove a high-grade glioma.

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 two to three weeks and the drug is slowly released into the brain. You may be given 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.

We have more information about the side effects of Gliadel® implants.

Back to Chemotherapy explained

How do chemotherapy drugs work?

Chemotherapy drugs work by stopping cancer cells reproducing. The drugs can also affect healthy cells, causing side effects.