Neuro-Oncology University of Washington Medical Center

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Treatment Strategies Chemotherapy Chemotherapy is the treatment of a disorder with pharmaceuticals (drugs or medication). Chemotherapy is usually recommended for the treatment of higher grade tumors and for recurrent tumors. It may be given before, during, or after radiation therapy, or it may be reserved for use if the tumor recurs. The chemotherapy may be given orally, intravenously, intra-arterially, or, rarely, into the spaces surrounding the brain or into the tumor directly. The goal of chemotherapy is to prevent any surviving tumor cells from dividing, thereby destroying the tumor. There are many different kinds of chemotherapy available for the treatment of brain tumors. Generally, the types of chemotherapy recommended are ones that have the ability to penetrate through the blood brain barrier. The blood brain barrier refers to a mechanism within the brain which only allows certain kinds of materials to pass into the brain. Even though this barrier is often disrupted, or not working, in some areas surrounding a malignant glioma, there may still be some tumor cells in areas in which the barrier is intact. The goal of treatment is to deliver the chemotherapy to all tumor cells. In addition to standard chemotherapeutic drugs, newer approaches are being developed to boost the ability of a person's immune system to attack and destroy tumor cells. Another method being developed employs genetic manipulation of cells. Both approaches may hold promise for the future. Chemotherapy affects cells that are dividing, therefore cells that divide the fastest are most affected. For this reason, an individual's bone marrow, where blood cells are manufactured, and hair follicles, which generate hair growth, may also be affected by the chemotherapy. The extent to which the various blood cells and hair follicles are affected varies with each individual and with the type of chemotherapy given. Another method of treating brain tumors with chemotherapy involves delivering the chemotherapy directly to the tumor. One method used to achieve this is the implantation, around the tumor resection bed, of "wafers" which contain chemotherapy. These wafers are placed during surgery after tumor tissue has been removed. The wafers (Gliadel wafers) are the size of a dime and contain chemotherapy which is released for 6 to 8 weeks after they are implanted. Your neurosurgeon or neuro-oncologist can provide you with additional information regarding this treatment. Clinical trials The neuro-oncology service is involved in the testing of new anticancer drugs, clinical trials, which may benefit patients with brain tumors. If chemotherapy has been recommended as part of your treatment, you may be eligible to participate in a clinical trial. If interested, you can ask your physician if this is a possibility in your situation. Chemotherapy: What to expect Chemotherapy is generally given in cycles. For example, one or more medications are given on one or more specified days, followed by a period of several weeks during which no medication is taken. The length of the period of no medication is determined by the estimated length of time it generally takes "blood counts" to recover or to return to normal levels (explained below). Some cycles may only be a week long, while others may be four or six to eight weeks. One cycle is comprised of the days that the chemotherapy is taken as well as the period of time during which the blood counts are recovering. Some chemotherapy is given continuously for many cycles as long as the tumor shows a response (does not grow or decreases in size). Other chemotherapy drugs are "dose limited," meaning the total amount of the drug which safely can be given is limited. Often, the physician recommends that six to eight cycles of a given chemotherapeutic drug be given. This could mean that one course of chemotherapy could take up to a year or more to complete. It is very important to have your blood tested for analysis of blood cell counts and chemistries as often as your physician requests. This is because it is possible for the chemotherapy to significantly lower your blood counts. Most frequently, the chemotherapy affects the white blood cells, the platelets, and the red blood cells. The white blood cells are necessary to "fight" infection. The platelets help the blood to clot, and the red blood cells carry oxygen to the body's tissues. If these blood cell counts become severely decreased in number, you may be more prone to infection, to having increased bleeding tendencies, or to experience a serious degree of fatigue. These conditions can be dangerous and may require intravenous antibiotics or blood transfusions, depending upon which blood components are affected. It is important to have your blood counts checked weekly because the dose of each chemotherapy cycle is based upon how much your blood cell counts decreased during the previous cycle. Your blood counts provide important information for the physician to calculate a "safe" dose of chemotherapy for your next cycle. Frequent blood draws and intravenous medications can sometimes affect your veins making blood draws difficult. If this happens, a temporary device can be implanted into the large subclavian vein located in your upper chest. This device is called a "Porta-Cath." Many patients find this to be a more comfortable alternative to weekly intravenous blood draws. If you are interested in additional information regarding Porta-Caths please request this from your physician or nurse. Most common side effects Some of the more common side effects associated with chemotherapy include bone marrow toxicity which causes your blood counts to fall, nausea and vomiting, and hair loss (alopecia). Other side effects are specific to the particular chemotherapeutic medication. Information on all potential side effects will be given to you by your physician. Blood cell counts may be lowered with many chemotherapy drugs. If white blood cells are affected, they will decrease in number, and could decrease to a level which can place you at increased risk for infection. Should this occur, you may be asked to remain at home and to wear a protective mask over your nose and mouth if you need to leave your home. You should also avoid gardening since any cut could expose you to infectious elements. You should report any signs of infection, such as coughing, sore throat, or burning on urination, to your nurse or physician. Should your white count decrease to a very low level, you will be requested to take your temperature every four hours and to report to the emergency room immediately if you develop a fever. A fever could indicate that an infection is present and you will need to have I.V. antibiotics. Dietary measures will not affect your white blood cells, either positively or negatively. Occasionally, a new medication which stimulates the bone marrow to manufacture white blood cells, will be prescribed to be given during a chemotherapy cycle. This medication is named G-CSF, granulocyte colony stimulating factor. Sometimes this medication causes some bone pain. Usually this pain is mild and can easily be managed with pain killers such as acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs like Advil. If your platelets decrease in number, you will be at increased risk for bleeding. Should this occur, you will be notified and asked to take care when brushing your teeth-use a soft bristle tooth brush and do not floss your teeth. If your gums continue to bleed when using a soft bristle brush, you can use a soft cloth to clean your teeth and mouth. Should your platelets drop to a very low level (this rarely happens), you will need to have a platelet transfusion. Your red blood cells may also be affected by chemotherapy. When red blood cells decrease in number, you will be anemic. Most often this is a mild anemia which requires no treatment. Iron supplements, or eating iron-rich foods such as red meat, can help to correct this anemia. Rarely, the red blood cells could decrease to a very low level which would require you to have a blood transfusion. Refer to the Handouts, "Blood Counts and Infections, A Guide for Patients with Cancer",and "Watching Your Blood Counts", for additional information. Nausea and vomiting can occur with some of the chemotherapeutic drugs. Many people have heard "horror" stories about chemotherapy. However, with the advent of newer antinausea drugs (antiemetics), and various combinations of older medications, nausea and vomiting are often eliminated or kept to a minimum. Be sure to inform your nurse or physician any time you have nausea, so that your antinausea medication can be adjusted accordingly. Sometimes we may need to try several combinations of medications to find what works best for you. Your nurse will have additional information on chemotherapy and tips on diet while you are taking chemotherapy. A dietitian is also available to talk with you regarding dietary problems or concerns. Some chemotherapy drugs can cause temporary hair loss. With most of the chemotherapy regimens that we use to treat brain tumors, this usually does not occur. However, we do occasionally encounter this with certain types of chemotherapy. Hair regrowth can be anticipated, in most instances, once the chemotherapy is discontinued. Your nurse will have information on alternative hair solutions for hair loss if you are interested.  Top of Page   |  Next Page