Chemotherapy for Brain and Spinal Cord Tumors in Children

Chemotherapy (chemo) uses anti-cancer drugs that are usually given into a vein (IV) or taken by mouth. These drugs enter the bloodstream and reach almost all areas of the body. However, many chemo drugs aren’t able to enter the brain and reach tumor cells.

For some brain tumors, the drugs can be given directly into the cerebrospinal fluid (CSF, the fluid that bathes the brain and spinal cord), either in the brain or into the spinal canal below the spinal cord. To help with this, a thin tube known as a ventricular access catheter may be inserted through a small hole in the skull and into a ventricle during a minor operation. (See Surgery for Brain and Spinal Cord Tumors in Children.)

When might chemotherapy be used?

In general, chemo is used for faster growing tumors. Some types of brain tumors, such as medulloblastomas, tend to respond well to chemo.

Chemo is most often used along with other types of treatment such as surgery and radiation therapy. It may be used instead of radiation therapy in children 3 years and younger.

Which chemo drugs are used to treat brain and spinal cord tumors?

Some of the chemo drugs used to treat children with brain or spinal cord tumors include:

• Carboplatin
• Carmustine (BCNU)
• Cisplatin
• Cyclophosphamide
• Etoposide
• Lomustine (CCNU)
• Methotrexate
• Temozolomide
• Thiotepa
• Vincristine

These drugs may be used alone or in various combinations, depending on the type of brain tumor. Doctors give chemo in cycles. Each cycle generally lasts for a few weeks and is followed by a rest period to give the body time to recover.

Possible side effects of chemotherapy

Chemo drugs can cause side effects. These depend on the type and dose of drugs, and how long treatment lasts. Possible side effects can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells or other factors)

Some of the most effective drugs against brain tumors tend to have fewer of these side effects than other common chemo drugs, but they can still occur. Most side effects tend to go away once treatment is finished. Your child’s doctor and treating team will watch closely for any side effects. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.

Some chemo drugs can also have other, less common side effects. For example, cisplatin and carboplatin can also cause kidney damage and hearing loss. Your child’s kidney function and hearing will be checked periodically if they are given these drugs.

Be sure to ask your child’s doctor or nurse about medicines to help reduce side effects, and let them know if your child has side effects so they can be managed. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.