Chemotherapy for rhabdoid tumours

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This page describes the use of chemotherapy for rhabdoid tumours.

Key points

  • Chemotherapy may be used to cure the tumour, control the tumour, or improve quality of life.
  • Side effects of chemotherapy can include: nausea and vomiting; allergic reaction; fatigue; low blood counts; digestive issues; hair loss; and behaviour changes.
  • Drugs can be prescribed to improve the side effects of chemotherapy.

Chemotherapy is the use of drugs to destroy tumour cells. These drugs are also called anticancer drugs or chemotherapeutic agents. Generally, children tolerate chemotherapy better than adults. They can usually carry on their normal activities.

Why does my child need chemotherapy?

Chemotherapy will help treat your child’s brain tumour. The treatment team is led by a doctor called a neuro-oncologist. They take the responsibility for your child’s care during chemotherapy, and makes the decisions about your child’s treatment plan.

Here are possible reasons why chemotherapy may be given:

  • To cure the tumour: With some types of brain tumours, chemotherapy can destroy all the tumour cells.
  • To control the tumour: Chemotherapy may be given after surgery to destroy any tumour that was left behind, or other tumour cells that are too small to see. This is to try and stop the tumour from growing again. It will also stop it from spreading to other parts of the brain or spine.
  • To improve quality of life: If a cure is not possible, chemotherapy may be given to reduce symptoms.

How is chemotherapy given?

There are many different types of chemotherapy medicines. Each drug acts in a different way. Some medicines must be given at the hospital. Others can be taken at home.

Sometimes more than one drug is given. Chemotherapy may also be given with surgery or radiation.

Chemotherapy treatment is delivered based on a set schedule or protocol that is based on your child’s specific condition. Usually each course of treatment involves a treatment period, and then a recovery period. Then this is repeated. The overall cycle of chemotherapy treatment can last weeks up to years. Within the treatment period, the drugs may be taken daily, weekly, or monthly.

There are several different ways to give chemotherapy. This depends on the tumour, on the medicine being used, and on your child’s situation.

  • Oral: This means that a pill or capsule is swallowed by mouth.
  • Intravenous (IV): This is the most common way to give chemotherapy. The drugs are delivered through a needle directly into a vein. A port or central line may be used.
  • Intramuscular (IM): Chemotherapy may also be injected into a muscle. This method is not as common.
  • Intrathetically: The medicines are given via a lumbar puncture. This is used to treat cancer cells in the cerebrospinal fluid (CSF).

How do chemotherapy drugs work?

Tumour cells grow very quickly. Chemotherapy drugs damage tumour cells as they are dividing and making new cells. The drugs are carried in the blood to all parts of the body.

Some types of normal cells also grow quickly, and they may also be damaged. This includes cells in the mouth, stomach, hair, and bone marrow, where blood cells are made. This can cause side effects. The damage to normal cells does not last long. Most of these side effects will go away after chemotherapy ends.

What is involved in intravenous chemotherapy?

Chemotherapy drugs are injected into a vein. These drugs may be given many times over many months. This can be difficult for children, both physically and emotionally. One key problem is that children’s veins are small. Chemotherapy can damage veins after many injections. To avoid this problem, a thin tube may be inserted into a larger vein to give the drugs. This tube is called a central venous catheter or central line. Once it is inserted, it will safely stay in your child during the entire treatment period. With a central line, your child won’t have as many injections. There will be less damage to his veins.

The central line

A central line is a special type of tube. It is placed in one of the large veins leading to the heart. Your child may have a central line for one or more of the following reasons:

  • to receive chemotherapy, antibiotics, or other medicines
  • to receive total parenteral nutrition (TPN); this is a type of intravenous nutrition needed when your child cannot eat or absorb nutrients
  • to receive blood or blood products
  • to provide blood samples
  • to receive IV fluids when your child cannot drink
  • to receive treatments such as haemodialysis or plasmapheris

There are different types of central lines:

  • external catheters that can be seen outside the body
  • subcutaneous (SC) ports that are covered by the skin on the upper chest
  • peripheral access ports (PAP) or peripherally inserted central catheters (PICC) that are covered by the skin on the arm

What is a subcutaneous port?

This is also known as a Port-a-Cath or just a port. It consists of a small box and a soft tube. The tube connects the port to the large vein in the neck. The port is located in the upper chest and is completely under the skin. It is used to deliver medicines.

What is involved in getting a central line?

The central line is put in the body during surgery. Your child will be under anaesthesia during this operation.

Using antibiotics

During chemotherapy, your child may need to take antibiotics to prevent a lung infection called Pneumocystis carinii pneumonia (PCP). The antibiotic is a combination of two medicines called trimethoprim and sulfamethoxazole. It is called Cotrimoxazole, and is commonly known as Septra or Bactrim, its brand names.

Why does my child need to take antibiotics?

PCP is believed to be caused by bacteria that is probably present in most healthy children’s lungs. When your child’s immune system is weakened during chemotherapy, his body loses the ability to cope with infections. As a result, your child may be at higher risk of developing this type of pneumonia.

Taking antibiotics is effective at preventing PCP from developing. This is called preventive or prophylactic use of antibiotics.

The antibiotics are usually given by mouth in a tablet or liquid form. They are taken once or twice a day, three days a week throughout treatment, and for three to six months after treatment.

Mouth care before and during treatment

Radiation therapy and chemotherapy drugs can affect the teeth and mouth. Some of the side effects are a sore mouth or throat, and a dry mouth. There may be a higher risk of your child developing cavities. If possible, arrange a checkup with your child’s dentist before treatment begins. During treatment, regular brushing may not be possible. If this is the case, the treatment team will provide you with alternate options for mouth care.

Monitoring during chemotherapy

While your child is getting chemotherapy, they will have regular checkups. It is important to tell the treatment team about all of the changes or symptoms they have while at home. The treatment team will ask about their appetite, daily activities, pain, bowel movements, weakness in their fingers or toes, headaches, and vision problems. There will also be a physical exam. A complete blood count will be checked. If they are getting certain medicines, they will be sent for a hearing test. They may be given other medicines also, such as antibiotics to prevent pneumonia, pain medicines, and others.

Side effects of chemotherapy

Some medicines have unwanted effects on the body. These are called side effects.

The side effects from chemotherapy drugs depend on the type of drugs, the dose of drug, and your child’s reaction. Some children may not have any side effects.

Within 30 minutes to a day

  • nausea
  • vomiting
  • allergic reaction

Within two or three weeks

  • fatigue
  • low blood counts (myelosuppression): There are three main types of blood cells. All three types can be affected.
  • low number of white blood cells (neutropenia)
  • low number of platelets (thrombocytopenia)
  • low number of red blood cells (anaemia)
  • loss of appetite
  • sore mouth or throat
  • diarrhea
  • constipation
  • taste changes
  • pain and damage to the ends of nerves in hands, feet, or jaw (neuropathy)
  • hearing loss
  • hair loss
  • possible changes in mood or behaviour

How will chemotherapy lower your child’s blood counts?

Chemotherapy may damage your child’s normal cells that are quickly multiplying. One type of cell that is affected is bone marrow. This is the soft fatty material in the middle of bones where new blood cells are being made. Chemotherapy damages the new blood cells that are made in the bone marrow, but not the older blood cells that are already in the rest of the body.

How long does it take to lower your child’s blood counts?

It takes one to two weeks after your child starts chemotherapy to lower the blood counts. That is how long it takes for the older blood cells to die and the newer blood cells to be made.

Usually, your child's blood counts will return to normal within three to four weeks after starting chemotherapy.

Understanding your child’s blood

Your child’s blood is made up of billions of tiny cells that you cannot see.

The three main types of blood cells are red blood cells, white blood cells, and platelets.

Red blood cells are the part of the blood that carries oxygen to the rest of your child’s body. The part of the red blood cell that carries the oxygen is called haemoglobin. Red blood cells give your child energy and make her skin a healthy colour.

White blood cells protect your child from infection. They find and kill the germs called bacteria in your child’s blood. There are many types of white blood cells. The type you will hear about most is the neutrophil. The number of neutrophils in your child’s blood is called the poly count.

Platelets are the small round flat cells in the blood. They look like plates. Platelets help the blood clump, or clot.

What is a complete blood count?

When your child is having chemotherapy, the treatment team will check each type of blood cell in your child to see how they are being affected. To do this, they will take blood from your child. Then they will do a complete blood count, also called a CBC, to look at these four blood counts:

  1. a white blood cell count
  2. a neutrophil count, also called a poly count
  3. a red blood cell count and a hemoglobin count
  4. a platelet count

What can be done to deal with the side effects of chemotherapy?

The doctor may recommend several drugs to improve the side effects. Some of these drugs are used specially for chemotherapy. If you notice side effects or changes in mood or behaviour, let your treatment team know.

For more information, see the page entitled "Side Effects of Chemotherapy"

What is high-dose chemotherapy?

High-dose chemotherapy involves giving very high doses of drugs to destroy tumour cells. Because it also causes many blood cells to die, it must be given with a procedure that helps the body build healthy new blood cells. This is called peripheral stem cell support.

What is peripheral stem cell support?

Peripheral stem cell support helps the body create healthy new blood cells after high-dose chemotherapy. This is done by first taking stem cells from the body before high-dose chemotherapy. These cells avoid contact with chemotherapy drugs. This process is called apheresis.

These stem cells are stored and given back to the child. Once in the body, stem cells develop into different types of blood cells: red blood cells, platelets, or white blood cells.

Most stem cells are located in bone marrow, but there are some in the blood. They are collected from the blood in this procedure because it is easier than getting it from the bone marrow.

What will my child experience?

Stem cells are obtained by a process called apheresis. Apheresis is similar to dialysis. Your child will be given granulocyte colony stimulating factor (GCSF) to stimulate the bone marrow to make white blood cells. Your child will have a double lumen central line put in.

During this time, the blood is removed from the body from the first lumen. It goes to a machine called a cell separator. This machine removes the immature cells and returns the rest of the cells to the body through the second lumen. Your child will need to have enough liquid in his body. Your child will get intravenous (IV) fluids for at least six hours after each infusion.

The procedure is not painful, but it takes four to six hours. Your child will have to stay in bed during the procedure. The total amount of blood collected will be 100 to 500 mL (half a cup to two cups).

This may need to be repeated if enough stem cells were not collected. The cells are then stored and frozen, and will be given back to your child during treatment.

What are the side effects?

  • nausea or vomiting
  • fainting or dizziness
  • seizures
  • skin rash
  • hives
  • flushed skin (usually the face)
  • blood loss
  • infection
  • tingling of lips, muscle cramping
  • in rare cases, change to heart rhythm
  • very rarely (less than one in 1,000 procedures), there is clotting

What can be done?

Calcium is given either by mouth or intravenously, through the central line in place.

Children may be given acid-citrate-dextrose (ACD) to reduce the risk of clotting. This drug may increase risk of bleeding, tingling, cramping, seizures, or changes in heart rhythm.

Are there any risks involved with giving the blood back?

Risks may include change in colour of urine, nausea, vomiting, fever, chills, or increased blood pressure. These changes are temporary and will go away after the infusion ends. The stem cells will take some time in the body to mature and divide. This can take 10 to 20 days after the infusion. During this time, your child must not have contact with anyone who has an infection.

What is informed choice or informed consent?

Informed choice is the option a person has to allow or not allow something to happen, like diagnostic procedures or treatment, after they have been informed of the benefits and risks of the options involved. If the person agrees, they give informed consent. Informed consent is required before beginning chemotherapy.

Last updated: July 10th 2009