Chemotherapy for childhood brain and spinal cord tumours

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. It is sometimes used to treat childhood brain and spinal cord tumours. The healthcare team will consider your child’s needs to plan the drugs, doses and schedules of chemotherapy. Your child may also receive other treatments.

Chemotherapy is sometimes combined with radiation therapy to treat childhood brain and spinal cord tumours. The 2 treatments are given during the same time period to improve the effect of radiation.

Chemotherapy is given for different reasons. Your child may have chemotherapy:

• to destroy cancer cells left behind after surgery or radiation therapy and reduce the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
• to shrink a tumour before other treatments such as surgery or radiation therapy (called neoadjuvant chemotherapy)
• instead of radiation therapy to treat a tumour in children under the age of 3

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the brain or spinal cord. The drugs may be given by mouth or by a needle in a vein (intravenously). Sometimes a special device called a central venous catheter may be used to safely give the drugs. It is usually placed during surgery at the start of chemotherapy and left in place until treatment is finished.

Chemotherapy may also be a regional therapy, which means that it is given to a specific area of the body.

Chemotherapy may be given through a lumbar puncture into the space around the spinal cord containing the cerebrospinal fluid (CSF).

Intratumoral chemotherapy is used to give chemotherapy directly into a tumour. With some types of brain tumours, the surgeon may line the area where the tumour was removed with special wafers (glial wafers or Gliadel). These wafers have concentrated doses of a drug, which is released into the brain tissue as the wafers break down.

The most common chemotherapy drugs used to treat childhood brain and spinal cord tumours are:

• vincristine (Oncovin)
• carboplatin (Paraplatin, Paraplatin AQ)
• carmustine (BiCNU, BCNU)
• cisplatin (Platinol AQ)
• cyclophosphamide (Cytoxan, Procytox)
• etoposide (Vepesid, VP-16)
• lomustine (CeeNU, CCNU)
• methotrexate
• temozolomide (Temodal)
• thiotepa (ThioTEPA)
• irinotecan (Camptosar)
• ifosfamide (Ifex)
• bleomycin (Blenoxane)

Side effects can happen with any type of treatment for childhood brain and spinal cord tumours, but every child’s experience is different. Some children have many side effects. Other children have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If your child develops side effects, they can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

It is hard to say exactly which side effects a child will have, how long they will last and when the child will recover. A child’s body seems to handle chemotherapy better than an adult’s body. Children usually have less severe side effects and will often recover from them faster than adults.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and the child’s overall health. Some common side effects of chemotherapy drugs used for childhood brain and spinal cord tumours are:

• hair loss
• sore mouth
• loss of appetite
• nausea and vomiting
• diarrhea
• low blood cell counts (bone marrow suppression)
• low white blood cell count
• infection
• low platelet count
• anemia
• fatigue
• constipation
• nerve damage
• hearing loss
• kidney damage
• allergic reactions
• fertility problems

Other side effects can develop months or years after treatment for brain and spinal cord tumours. Find out more about late effects of treatments for childhood brain and spinal cord tumours.

Tell the healthcare team if your child has these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help your child.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for your child, ask your child’s healthcare team questions about chemotherapy.