Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
Chemotherapy can work well for some types of brain tumour. But it can be difficult to treat some brain tumours with chemotherapy drugs because the brain is protected by the blood brain barrier. This is a natural filter and only lets certain substances through from the blood to the brain tissues.
Children with a brain tumour might have chemotherapy treatment for up to two years.
Will my child have chemotherapy?
Your child might have chemotherapy:
- after surgery for some types of brain tumour, to try and stop it coming back
- with radiotherapy and for some months afterwards
- if they have a brain tumour that has come back after treatment
Very young children (less than 3 years old) might have chemotherapy instead of radiotherapy. It depends on their type of brain tumour. This is to avoid radiotherapy when they are very young. Once they are over 3 years, they can have radiotherapy.
Chemotherapy treatment can work very well for some types of brain tumours in children. So, they might not need any radiotherapy after a year or so of chemotherapy treatment.
Your child’s specialist will be able to discuss the best treatment options for your child.
Chemotherapy drugs for children under 3 might include:
- high dose methotrexate
The types of chemotherapy drugs available for children over 3 are very similar. They might also have a drug called temozolamide.
How often will my child have chemotherapy?
Your child will usually have chemotherapy in cycles. This means that your child will have the drugs for a few days every few weeks. There is a time with no treatment when they recover from the side effects.
How often they have treatment depends on the particular drug or drugs that they are having.
Your child might have their chemotherapy as liquid or tablets. This is called oral chemotherapy.
Or they might have it through a vein into the bloodstream. This is called intravenous chemotherapy.
At first, the nurses might give your child’s chemotherapy through a cannula. This is a small tube that is put into your child’s hand or arm.
When they aren’t having treatment, your child’s nurse wraps it up with a soft bandage so it’s covered and your child can’t take it out.
Your child might have further treatment through a long flexible plastic tube called a central line. There are different types including a PICC line or port-a-cath. They are called central lines because they end up in a central blood vessel close to the heart. They run up under the skin to a large vein by the collarbone.
These lines can stay in for much longer than cannulas. Sometimes for over 2 years. This means your child doesn’t have to have a cannula each time they have treatment. The nurses can also take blood from these more permanent lines.
We have more information about the different types of central lines. This information is written for adults with cancer, but some of the information and pictures might be helpful.
Chemotherapy into the spine (intrathecal chemotherapy)
Chemotherapy travels through the bloodstream to most parts of the body. But, most chemotherapy doesn’t reach the area around the brain and spinal cord well. So, it’s injected into the cerebrospinal fluid to destroy cancer cells in that area.
This is called intrathecal chemotherapy.
Your child’s doctor injects the drug into the fluid around the spinal cord during a lumbar puncture. This diagram shows a girl having a lumbar puncture.
Most children and young people have this test under general anaesthetic. Or they might have a medicine to make them feel sleepy and relaxed (sedative). This helps them lie still on the couch for the test.
Chemotherapy into the brain
During surgery your treatment team might put a plastic dome under the skin of your child’s scalp. It's called a ventricular access device or an Ommaya reservoir.
Your child’s doctor or nurse gently puts a small needle through your child’s skin into the reservoir. And the chemotherapy is given straight into the fluid filled spaces in the brain. So, it goes straight into their cerebrospinal fluid (CSF). This bypasses the blood brain barrier, which means doctors can give smaller doses of chemotherapy.
Your child’s surgeon might put chemotherapy drugs into the brain tissue as a wafer (implant). The chemotherapy drug itself is inside a gel wafer, which slowly dissolves over 2 or 3 weeks.
As it dissolves, the chemotherapy slowly releases into the brain tissue. One example is a Gliadel wafer that contains carmustine (BCNU). This type of chemotherapy treatment is rare in children.
Side effects vary from one child to another. It is difficult to predict how your child will be and what side effects they will have. Some children have only mild side effects but for others the side effects are more severe.
Your child’s consultant will go through the benefits and potential side effects of treatment with you. And with your child if they are old enough.
The doctors and nurses looking after your child do everything possible to prevent and treat any side effects that come up. The side effects usually go away quite quickly after treatment stops. But some last longer or start after treatment has finished.
Common short term side effects of chemotherapy include:
- increased risk of getting an infection
- anaemia (low red blood cell counts)
- increased risk of bleeding
- hair loss
- tiredness and weakness
- feeling or being sick
- sore mouth
- allergic reactions
Long term side effects
Some children with a brain tumour develop longer term late effects of treatment. These might be from chemotherapy or from a combination of treatments.
These are different for every child. But some possible long term side effects of chemotherapy include:
- fertility problems
- bone problems
- changes in how the kidneys and heart work
- growth problems
- a risk of developing a second cancer
Your child’s doctor will talk to you about the possible risks depending on the treatment your child has had. They will continue to keep a close eye on your child, so that any problems can be treated early.