About brain tumour chemotherapy

• A quick guide to what's on this page
• What chemotherapy is
• Chemotherapy for brain cancer
• The blood - brain barrier
• Chemotherapy for children with brain tumours
• How you have chemotherapy
• Chemotherapy into the spine
• Implantable wafers
• Taking nutritional supplements or herbal treatments with chemotherapy
• Where to find out more about chemotherapy

Chemotherapy uses anti-cancer or 'cytotoxic' drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. As they circulate in the blood, they can reach cancer cells wherever they are in your body.

You may have chemotherapy

• After surgery, to try to prevent a brain tumour from coming back
• To treat brain tumours that have come back since they were first treated
• To shrink a brain tumour that cannot be operated on
• To shrink a tumour, or reduce its blood supply so that an operation is easier to do

Not all brain tumours respond to chemotherapy. So specialists don't suggest it for every type of brain tumour. You are most likely to have chemotherapy for

• High grade glioma
• Gliomas in children
• Oligodendroglioma
• Ependymoma
• High grade meningioma that has come back
• Primitive neuroectodermal tumours (PNETs) in children
• Primitive neuroectodermal tumour that has come back
• Germinomas of the pineal gland
• Other pineal region tumours
• Spinal tumours in children
• Primary lymphoma of the central nervous system
• A secondary brain tumour that has spread to the brain from cancer somewhere else in the body

It can be difficult to treat brain tumours with chemotherapy because of the blood - brain barrier. This is a natural filter within the body. It only allows certain substances through from the blood to the brain tissues. This is a natural defence mechanism. It is designed to keep harmful substances out of the brain. Only a few chemotherapy drugs can get across the blood - brain barrier.

Very young children (less than 3 years old) with primitive neuroectodermal tumours (PNETs), ependymomas or gliomas may have chemotherapy instead of radiotherapy. This is so that they don't have to have radiotherapy at such a young age. Your child will have the same chemotherapy drugs repeated every few weeks for up to 2 years. This treatment seems severe, but it is designed to reduce the long term side effects that radiotherapy can have in very young children. Once the child is over 3 years old, they can have radiotherapy.

For some types of brain tumours in children, it may be possible to avoid giving radiotherapy altogether after a year or more of chemotherapy treatment. This research is still experimental. We are not yet sure that this is a safe approach for all types of childhood brain tumour, so your child's specialist is in the best position to advise on the exact treatment.

You may have chemotherapy

• As a tablet
• Into a vein
• Into your spinal fluid (intrathecally)
• Into the area of a brain tumour

You have most chemotherapy drugs directly into your bloodstream, either as an injection into a vein or in a bag of fluid through a drip (IV). You can take some drugs by mouth, for example temozolomide, procarbazine or lomustine (CCNU). The obvious advantage of this is that you can have most or all of your treatment at home as an outpatient. But you may have treatment with a combination of several drugs, some of which are tablets and some given as injections or through drips.

To allow you to recover from the side effects, you have chemotherapy for a few days every few weeks. How often you have treatment will depend on the drug or drugs that you are having.

Methotrexate is a chemotherapy drug that you can have injected into the spine to treat brain tumours. You have the drug into the spinal canal. This is known as intra-thecal treatment, which can be shortened to ‘IT’. The drug mixes with the spinal fluid and circulates throughout the brain.

There is a different way of having chemotherapy for brain tumours. The chemotherapy drug is fixed inside a gel wafer. At the end of your brain tumour operation, the surgeon puts the wafers inside the brain, in the area of the tumour. Over 2 or 3 weeks the gel dissolves. As it does so, it slowly releases the chemotherapy drug directly into the brain.

One type of these wafers are called Gliadel wafers. These contain carmustine (BCNU). Gliadel wafers are mostly used to treat high grade gliomas. They can be implanted during surgery to remove or debulk the tumour. Clinical trials have shown that Gliadel wafers can lengthen survival time and help to control symptoms of high grade gliomas for longer than surgery and radiotherapy alone.

The wafers are licensed for use in the UK for glioma brain tumours that have just been diagnosed or have come back since they were first treated. In June 2007, NICE (National Institute for Health and Clinical Excellence) recommended carmustine wafers as a possible treatment for newly diagnosed high grade gliomas, if at least 90% of the tumour can be surgically removed.

There is increasing concern amongst doctors about dietary supplements and herbal medicines. Doctors often don't know what their patients are buying over the counter or getting from alternative or complementary therapy practitioners. There is nothing wrong with trying to help yourself get better, of course. But we don't know enough scientifically about how some supplements may interact with chemotherapy.

Talk to your specialist about any other tablets or medicines you take while you are on active treatment. It may not be a good idea to take anything that claims to boost your immune system, for instance. Some specialists are already telling people with lymphomas or leukaemias that they should avoid these. We just don't know how supplements may interact with treatment for other types of cancer as yet.

There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section of CancerHelp UK.

For more about chemotherapy look at the main chemotherapy section in CancerHelp UK. It explains the treatment in more detail including

• How it works
• How chemotherapy is planned and given
• General side effects
• Living with chemotherapy. If you would like more information about chemotherapy, ask your chemotherapy nurse or contact one of the cancer information organisations. They would be happy to help