Information for brain tumour patients receiving chemoradiation

Chemoradiation is a cancer treatment where chemotherapy medication and radiation therapy happen at the same time.

During your chemoradiation treatment, you will take chemotherapy medication (pills) before your radiation appointments.

The chemotherapy medication is used as a "radiation sensitizer" - it makes the radiation work harder.

Your chemoradiation treatment will last for 6 weeks.

There are 5 steps to follow during your chemoradiation treatment.

1) Pick up your prescription for chemotherapy pills from the Odette Cancer Centre Pharmacy.

2) Plan to take your chemo 1 hour before radiation treatment.

• For example: Your radiation treatment is planned for 10:00 am... Take your chemotherapy pill at 9:00 am

3) Take your chemotherapy pill

• Take your chemotherapy pill every day during the 6 weeks of your chemoradiation treatment, including weekends and holidays.
• On days you will have radiation treatment, please take your chemotherapy pill one hour before your radiation treatment.

4) Check in at the radiation therapy reception desk

• You will receive radiation treatment Monday through Friday for 6 weeks.
• Please take your chemotherapy pill one hour before you receive your radiation treatment.
• Follow the appointment times you were given for your radiation treatments.
• Go to the radiation therapy reception desk at T-wing, Ground Floor to check in for your radiation therapy treatments.

5) Receive radiation treatment

• You will receive radiation treatment Monday through Friday for 6 weeks.
• The first day of radiation treatment is the first day of the chemo.
• The last day of radiation is the last day of chemo.

• Chemotherapy will be in oral (pill) form
• The drug is called Temozolomide or TMZ
• The dose is based on your height and weight so it is different for each patient
• TMZ should be taken one hour before each radiation treatment
• On the weekends and holidays when you do not receive a radiation treatment, you should take the TMZ before you go to bed at night
• The prescription will come with an anti-nausea medication called Stemetil
• This should be taken 30 minutes before the TMZ

Radiation planning is an appointment with the radiation oncologist (a doctor) and the radiation technologist to prepare for the radiation treatments.

A mask will be made to ensure your head does not move during treatment and the radiation beams will deliver radiation to the same spot every day.

• You will check in for your radiation appointment on the Ground floor of the Odette Cancer Centre
• You will meet a radiation therapist who will explain everything that is going to happen
• You will lie down in the treatment room and the radiation therapist will set up the treatment area.
• Treatment usually lasts 15-30 minutes

• Dexamethasone (Decadron) is commonly prescribed for patients who have tumours in their brain or spinal cord.
• You may already be taking this medication when you come for your radiation therapy consultation, or you may be prescribed this medication by one of your doctors.

• Brain tumours can cause swelling and pressure. If this happens, you may feel headaches, increased weakness, numbness, nausea or vomiting.
• Decadron relieves swelling and pressure and helps you feel more comfortable.

• You should take the Decadron tablets exactly as prescribed by your doctor. Do not stop taking them unless advised when and how to by your doctor.
• Decadron should be taken with food.
• If you have diabetes, you should monitor your blood sugar levels closely. Decadron may increase blood sugar levels, and if you notice a change in these levels, you should check with your doctor.
• Make sure you have enough pills. Contact your doctor or pharmacy if you need a refill a few days before you run out.

• Mostly you will notice that you are more tired and this will get worse towards the end of the 6 weeks of treatment
• You will feel most tired the month after the radiation and TMZ have completed
• Take frequent rest periods and naps as needed during this time.

Side effects of Decadron are usually temporary and go away slowly after the medication is stopped. The following are possible side effects:

• Increased appetite
• Trouble sleeping
• Increased risk of infection - especially a yeast infection in the mouth. An anti-yeast medicine can be prescribed by your doctor for this infection
• Heartburn or indigestion. Your doctor will order a medication to treat or prevent this
• Increased blood sugar levels
• Weakness in thighs and upper arms
• Swelling in face, neck or ankles 

Tell your health care team about these side effects:

• Indigestion/heartburn especially if it wakes you up at night
• Sore throat
• Fever
• Swelling in your legs or feet
• Frequent urination
• Increased thirst
• Skin rash
• Bad taste in mouth/white tongue
• Change in mood/hallucinations
• Tell any doctor or dentist you visit that you are taking Decadron

There are 5 general side effects you can expect during your chemoradiation treatment: nausea, headaches, constipation and drop in blood counts.

Fatigue

Fatigue is the most common side effect of cancer treatment. It is normal to feel more tired while receiving chemoradiation treatment and maybe even after your treatment has completed.

Nausea

Although most patients do not have much trouble with nausea, you might find that you are nauseated despite taking the Stemetil (anti-nausea medicine) every day.

If this is so, please contact us as we can help manage the nausea with other medications.

Headaches

This can be due to the medication or the radiation.

• Use Tylenol or Extra Strength Tylenol.
• Call if headaches persist or worsen.

Constipation

May be related to medications or changes in your diet.

• You can use over the counter remedies such as  Colace (stool softener) or Sennekot (natural laxative).
• You can try prunes, prune juice or teas that have a laxative effect

Drop in blood counts

Blood Counts may be slightly lowered during treatment.

Red blood cells carry oxygen to all your vital organs, providing strength and stamina. White blood cells protect you from infection. Platelets are sticky cells that come together to form a clot and stop bleeding.

• What to do: We will check your blood routinely to watch for any drop in your counts.

• Please call if:
  • You have a fever greater that 38°C or 101°F
  • You have any signs of infection such as a cough or burning with urination
  • You have any unusual bleeding such as a nosebleed or blood in your urine

Not all patients experience seizures but a high rate of patients with brain tumours can have them.

If your doctor has given you an anti-seizure medication, you must take it every day and do not stop taking it unless you are told by your health care team.

Convulsant

• Is a full blown seizure where your arms and legs move around and you lose consciousness after the seizure has passed
• Seek immediate medical attention

Anti-convulsant

• Is a small seizure that may or may not be noticeable
• You may stop talking for a few seconds, you may have a tremor in your hand or arm or feel numbness in your leg
• If this occurs, find a quiet safe spot to      rest until it resolves
• Let your health care team know if this has occurred

Yes, you can have a flu shot. We recommend that you have a flu shot while getting treatment, unless you have had a reaction to it in the past.

Yes, you can go to the dentist while getting treatment and have your teeth cleaned and cavities filled. Please discuss any plans for having a tooth pulled with your health care team.

No, please do not take any vitamins or supplements while getting radiation therapy. Certain vitamins may interfere with radiation. Once you start chemotherapy, you can take vitamins and supplements but please give a list of everything you are taking to your health care team.

Yes, you can exercise while getting treatments but you will probably not feel like you can do 100% of your usual workout program. Try to modify your exercise program so that you do not make yourself so tired that you are not able to do anything else during the day. Please do not do any heavy lifting, straining or bending unless approved by your health care team as this may interfere with healing from surgery or radiation.

No, there is no special diet for people getting treatment for a brain tumour. We recommend that you eat a balanced diet with lean protein such as chicken or fish, complex carbohydrates like whole wheat bread and grains and lots of fruits and vegetables.

You can take Tylenol or Extra Strength Tylenol for a headache. If your headache gets worse or you have nausea or vomiting with it, please contact your health care team.

Yes, you can travel while getting chemotherapy. It is safe for you to fly on a commercial airplane.