Chemotherapy is the use of special anti-cancer (cytotoxic) drugs, which work by disrupting the growth of cancer cells.

Chemotherapy is not used to treat all brain tumours. It may be used for people with high-grade primary brain tumours where the tumour has come back. It may also be used as part of the treatment for secondary brain tumours. In these situations the chemotherapy is unlikely to be able to cure a brain tumour completely, but it can sometimes shrink a tumour down or slow its growth and so can reduce symptoms.

Chemotherapy drugs which may be used to treat primary brain tumours include: carmustine (BiCNU®), lomustine (CCNU), procarbazine, vincristine and temozolomide (Temodal®). Some are given as tablets or capsules, and some are given by injection into a vein (intravenously).

Another way of giving chemotherapy is by an implant which can be placed into the area of the brain tumour during surgery. These implants (called Gliadel® implants) are small gel wafers or discs which contain the chemotherapy drug carmustine. As the gel wafer dissolves, the drug is slowly released.

The type of chemotherapy you have will depend on the type and stage of your brain tumour. Chemotherapy to treat brain tumours can usually be given to you as an outpatient.

Chemotherapy may sometimes be used after surgery, or with, and after radiotherapy in people who have just been diagnosed with a brain tumour.

Assessing new chemotherapy treatments

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).

At present NICE is assessing both Gliadel implants and temozolomide for use in people with newly diagnosed high grade brain tumours (although temozolomide is already approved for people who have relapsed after, or not responded to, other chemotherapy drugs). They will issue guidance to doctors in the summer of 2007. These drugs have already been assessed and approved for use in people with newly diagnosed brain tumours in Scotland.

Chemotherapy can cause side effects, which can be unpleasant, and for some people chemotherapy will have little effect on the tumour, so 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 to have side effects. Making decisions about treatment under these circumstances is always difficult. It will be helpful to discuss with your doctors the possible benefits and side effects of chemotherapy in your situation. You can also talk to the nurses at Cancerbackup.

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

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 are 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.

If your temperature goes above 38°C (100.5°F), or you suddenly feel unwell even with a normal temperature, contact your doctor at the hospital straight away.

Anaemia

If the level of red blood cells in your blood is low you will become very tired and lethargic. You may also become breathless. These are symptoms of anaemia. If you become very anaemic, you may be given a blood transfusion.

Bruising and bleeding

Platelets are a type of cell that helps to clot the blood. If the number of platelets in your blood is low you will bruise very easily and may bleed heavily from even minor cuts or grazes. If you develop any unexplained bruising or bleeding, contact your doctor or the hospital immediately.

Feeling sick

Some chemotherapy drugs may make you feel sick (nauseated) and can also make you be sick (vomit). There are now very effective anti-sickness drugs (anti-emetics) to prevent or greatly reduce nausea and vomiting. Your doctor can prescribe these for you.

If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet. Our section on eating well, which has some useful tips on coping with eating problems.

Hair loss

The chemotherapy drugs commonly used to treat brain tumours do not usually cause hair loss but some may cause hair-thinning. If your hair does fall out while you are having chemotherapy, it will grow back over a period of 3−6 months.

It is important to remember that chemotherapy affects different people in different ways. Some people find that 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 overtire yourself. Although the side effects may be hard to bear at the time, they will gradually disappear once your treatment is over.