Chemotherapy

What is it?

Chemotherapy is a treatment that uses drugs to treat cancer cells, and the drug circulates around the body in the bloodstream. Sometimes more than one drug is used; this is called combination chemotherapy.

There are new drug therapies which are being developed which may control the growth of brain tumour tissue. These work differently to chemotherapy and so are not covered here.

How chemotherapy works

Chemotherapy directly attacks brain tumour cells and disrupts their growth. It is not used to treat all brain tumours, and sometimes it is used to shrink a tumour or slow its growth; it won’t always get rid of the tumour. It is generally used to treat a malignant tumour. The blood–brain barrier causes problems in the delivery of chemotherapy. The blood–brain barrier is there to protect the brain from toxic substances, so trying to deliver chemotherapy agents to the site is not easy.

Chemotherapy works on cancer cells in three ways:

1. It kills cancer cells.
2. It alters the cells damaging potential.
3. It ‘tees up’ the cancer cells for treatment with further drugs (also called prodrug therapy).

Should my child have chemotherapy?

There is no simple answer to this. Each case must be assessed individually. Your child’s healthcare team will suggest the best treatment options. What treatment is offered depends on your child’s tumour type, their age and their general health. To help you decide, ask about the drug’s main side effects and trust in your healthcare team. Be guided by this.

Such is the progress in personalised treatments that neuropathologists can now identify which tumours are likely to respond to chemotherapy. Specific tests might provide information that can be used to influence your child’s treatment and diagnosis. Not all hospitals run such tests, but you can ask for them. These tests (also called molecular markers) can:

• aid the diagnosis of brain tumours that are sometimes hard to diagnose
• allow clinicians to work out a prognosis
• indicate whether a tumour will respond to a specific type of treatment.

The downside of this is that you may discover that your child’s tumour type might not respond to treatment, so if you ask the question, you need to be prepared to receive information you may rather not know.

When will my child have chemotherapy?

Chemotherapy can be given at many stages in your child’s treatment. It can be given:

• on its own if it is known that the specific tumour responds well to chemotherapy only
• before surgery to shrink the tumour
• following surgery to prevent the tumour from coming back
• before, during or after radiotherapy
• when a brain tumour comes back.
• instead of radiotherapy if your child is under three years old.

How is chemotherapy given?

Your child may be given chemotherapy in a few different ways:

• Intravenous (IV) chemotherapy
  • Chemotherapy is given by an injection or a drip. Initially this may be given through a cannula on your child’s hand. In the long term, your child will be fitted with a tube. The type of tube is dependent on the tumour type and the purpose of the chemotherapy. They may get a central line, PICC line or a portacath.
  • A central line is a tube inserted under general anaesthetic into your child’s chest. It is inserted near their collarbone and runs through a vein into a large central blood vessel near their heart. The exit of the tube is on your child’s chest. By ‘exit’, we mean where the tube comes out of your child’s body so that medication can be pumped through it.
  • A PICC line is inserted in the arm, by a large vein that runs to the heart. The exit of the PICC line is in the arm.
  • A portacath is a small chamber that sits under the skin either on your child’s chest or under their arm. A portacath does not have a line coming out of it. It is all internal. The tube leads from the small chamber to a vein close to the heart. As there is no exit tube, medication is given by an injection to the port. Local anaesthetic is used to numb the area around the port before it is used.
• Oral chemotherapy by tablet or liquid
  • This is less common in children, as some drugs cannot be absorbed by the stomach. Children that are asked to take tablets as medication may need support to do so. Talk to the healthcare team, as they can discuss strategies with you that may help. Remember, do not crush the medicine unless you have been allowed to do so by the professionals. Oral medication should be taken as directed.
• Chemotherapy injected into the fluid surrounding the brain and spine (please note, this is very rare). This can be referred to as intraventricular or intrathecal chemotherapy.

How often will my child have chemotherapy?

Chemotherapy is given in cycles, with rest periods in between for your child to recover from the side effects. Each chemotherapy regime is usually given over a day or two every two weeks. How often chemotherapy treatment is given and over what period is dependent on the drugs being used.

How long will my child have chemotherapy for?

This again is tailored to your child and varies a lot. A lot of factors are involved in making the decision over length of treatment: your child’s tumour type, what treatments they have already had, your child’s general health, your child’s age and whether the tumour has responded to the initial cycles of chemotherapy.

Side effects of chemotherapy

It is hard to predict what side effects each child will have. It varies, and some children will have mild side effects, while others will experience more severe effects. The side effects of chemotherapy depend mainly on which drugs are given and the dosage.

Your child’s consultant will go through the benefits, risks and side effects of each treatment they prescribe. If you are worried about any side effects your child is experiencing, talk to their consultant and specialist nurse. They may have medication to relieve symptoms or better manage them.

As chemotherapy is given directly to the bloodstream, it will lower your child’s immunity. Your child’s blood will be taken regularly before chemotherapy is due to be given. This is to ensure that there is no infection. You also have to improve hygiene while your child is having chemotherapy, as they are at an increased risk of catching an infection.

Some short-term side effects are:

• hair loss
• constipation
• diarrhoea
• tiredness and fatigue
• being or feeling sick
• sore mouth
• lowered immunity
• low red blood cell count (anaemia)
• allergic reactions
• sensitive skin.

Questions you could ask your child’s team about chemotherapy

• What chemotherapy is being offered?
• What will the side effects be, physical and emotional? When will they kick in?
• If chemotherapy is offered, can my child have molecular testing to see whether the tumour will respond to the treatment?
• How long will it take for my child to recover from the treatment?