Chemotherapy for brain tumours: capsules, drips and radiotherapy

For the most common brain tumours in adults, the gliomas, chemotherapy is often taken as capsules at home rather than through a drip. After surgery, or a tissue sample when surgery is not possible, many people have radiotherapy every weekday for several weeks while also taking chemotherapy capsules each day. After a short break, further courses of capsules are usually taken for a few days in each cycle, repeated over several months. Some brain tumours are instead treated with chemotherapy through a vein, and a few people have medicine-soaked wafers placed in the brain during surgery. The approach depends on the tumour type, its genetic features and your general health, so plans differ widely between people.

Oral and intravenous chemotherapy each have a place. Capsules suit many gliomas because the medicine passes through the protective barrier around the brain, which blocks many other medicines. Chemotherapy through a vein is often used for some childhood brain tumours, lymphoma of the brain, which is treated with intensive drips in hospital, and certain slower-growing tumours treated with combinations. Radiotherapy is used alongside chemotherapy for many brain tumours in adults and children, because the two together can work better than either alone for some types. Tumours that have spread to the brain from cancers elsewhere, such as the lung or breast, are a separate problem and are treated according to where the cancer started.

Taking chemotherapy at home brings responsibility. Capsules must be taken exactly as prescribed, handled carefully and stored safely away from children. Blood counts are checked regularly, because low platelets and white cells are the commonest serious effects. Other typical effects include tiredness, feeling sick, constipation and loss of appetite. Steroids to reduce swelling around the tumour and medicines to prevent seizures are often taken as well, and need careful attention. A neuro-oncology team, including a neurosurgeon, radiation oncologist and medical oncologist, plans treatment together. This page explains the general picture and cannot describe your own plan. Your team will explain which treatments you need, in what order, and why they are recommended.

Often capsules at home

Many gliomas are treated with chemotherapy taken by mouth.

Often with radiotherapy

Capsules and radiotherapy are frequently given together first.

Some tumours need drips

Childhood tumours and brain lymphoma often use chemotherapy through a vein.

It cannot tell you which treatment suits your tumour. Brain tumours vary greatly, and so do their treatments.

It also cannot predict how your tumour will respond. Your neuro-oncology team can explain your scans and reports.

Genetic features of the tumour

Laboratory tests on the tissue sample look for genetic changes in the tumour cells. Some changes suggest a tumour is more likely to respond to chemotherapy, and others help confirm the exact type. These results strongly influence the plan, so ask your team to explain what your report shows.

Taking capsules safely at home

Take capsules exactly as prescribed, swallowed whole and never opened or crushed. Wash hands after handling them, keep them in their original packaging away from children, and return any unused capsules to the pharmacy. If you miss capsules or vomit after taking them, do not take extra; call your team for advice.

Preventing sickness

Anti-sickness medicine is often taken before chemotherapy capsules, and some people are advised to take capsules on an empty stomach or at bedtime. Follow the instructions you are given. Tell your team promptly if sickness stops you taking capsules or keeping food and fluids down, as other medicines can help.

Blood count checks

Chemotherapy for brain tumours can lower platelets and white cells, sometimes quite suddenly. Regular blood tests, including during radiotherapy, check that it is safe to continue. Your next course may be delayed or adjusted depending on the results, which is a normal part of safe treatment.

Steroids for swelling

Steroids are often prescribed to reduce swelling around the tumour and ease headaches or weakness. They can raise blood sugar, increase appetite, disturb sleep and affect mood. Your team usually reduces them gradually when it is safe to do so. Never stop steroids suddenly or change the amount without advice.

Seizure medicines

Many people with brain tumours take medicines to prevent seizures. Some can interact with other treatments, so tell every doctor and pharmacist what you take. Keep taking them as prescribed, and ask your team before stopping, even if you have not had a seizure for a long time.

Driving

A brain tumour, seizures or treatment can affect whether it is safe to drive. Rules and medical advice apply, and driving may need to stop for a period. Ask your team directly about driving, and arrange family support for travel to radiotherapy and clinic visits in the meantime.

Scans after treatment

MRI scans are repeated regularly. Soon after radiotherapy and chemotherapy, scans can sometimes look worse because of treatment-related swelling rather than tumour growth. Your team may repeat a scan after a few weeks before drawing conclusions, so try not to read too much into a single scan report on its own.

Children with brain tumours

Brain tumours in children are often different types from those in adults. Chemotherapy is frequently given through a vein, and radiotherapy may be limited or delayed in young children to protect the developing brain. Specialist paediatric neuro-oncology teams plan this care together with the family.

Tiredness during radiotherapy

Tiredness often builds over the weeks of combined treatment and can last for some time afterwards. Gentle activity, regular short rests, good nutrition and practical help with daily tasks all make a difference. Tell your team if tiredness becomes severe or suddenly worse, as low blood counts or steroid changes may be involved.

Memory, thinking and mood

The tumour, surgery, radiotherapy and some medicines can affect memory, concentration, personality and mood. Families often notice these changes first. Keeping notes, using reminders and asking for assessment by a psychologist or rehabilitation team can help people and their families cope and adapt at home and at work.

Rehabilitation

Physiotherapy, occupational therapy and speech therapy can help people regain strength, balance, speech and independence after surgery and during treatment. Starting early, even during treatment, often gives the best chance of improvement. Ask your team for a referral, and which exercises can safely be done at home between appointments.

What to do next

Ask your team what type of tumour you have, whether chemotherapy will be capsules or drips, how it fits with radiotherapy, how blood counts will be checked, and who to call if seizures or sudden changes occur.