Chemotherapy for brain and spinal cord tumours

Chemotherapy uses drugs to destroy cancer cells. These drugs target rapidly dividing cells throughout the whole body. This means that chemotherapy kills cancer cells but it can also damage healthy cells.

With most types of chemotherapy, the drugs travel through the blood to reach and destroy cancer cells all over the body, including cells that may have broken away from the primary tumour. This is described as systemic therapy. Brain and spinal cord tumours are different from most other types of cancer because they rarely spread outside the central nervous system (CNS) to other parts of the body. They may spread to nearby tissue in the area where they begin.

Most people with cancerous brain or spinal cord tumours have chemotherapy. It may be used for benign brain tumours if the tumour can't be removed with surgery.

If you have chemotherapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules.

You may have chemotherapy to:

• destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
• shrink a tumour before other treatments such as surgery or radiation therapy (called neoadjuvant chemotherapy)
• treat recurrent brain and spinal cord tumours along with surgery, radiation therapy or targeted therapy

The blood-brain barrier is a protective network of blood vessels and cells that filters blood flowing to the brain. This barrier makes it hard for substances to enter the brain. Many chemotherapy drugs can’t cross the blood-brain barrier in amounts large enough to destroy brain cancer cells. The chemotherapy drugs used to treat brain tumours must be able to cross the blood-brain barrier.

Your healthcare team will use the results of the cell and tissue studies that you had during diagnosis to recommend chemotherapy drugs for the type of tumour you have.

The most common chemotherapy drug used to treat brain and spinal cord tumours is temozolomide.

Other chemotherapy drugs that may be offered are:

• carmustine
• lomustine
• cisplatin
• carboplatin
• etoposide
• irinotecan
• methotrexate
• procarbazine
• vincristine
• cyclophosphamide

These drugs may be used alone or in combination with one another depending on the type of brain or spinal cord tumour being treated.

The most common chemotherapy drug combination used for brain and spinal cord tumours is PCV (procarbazine, lomustine and vincristine).

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

The chemotherapy drug carmustine may be used in special discs (Gliadel wafers) that are put in place after surgery is finished. The neurosurgeon lines the cavity where the brain tumour was removed with the discs. The discs slowly release the carmustine into the surrounding tissues to treat any remaining cancer cells.

Carmustine implants may be offered for newly diagnosed or recurrent glioblastomas that are removed by surgery.

Side effects of chemotherapy will depend mainly on the drug, the dose, how it’s given and your overall health. Tell your healthcare team if you have side effects that you think are from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Possible side effects of chemotherapy drugs used for brain and spinal cord tumours are:

• fatigue
• low blood cell counts
• loss of appetite
• nausea and vomiting
• sore mouth and throat
• diarrhea
• constipation
• hair loss
• skin problems

Carmustine implants may also cause:

• headache
• infection
• seizures
• confusion
• weakness
• increased intracranial pressure (ICP)

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

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