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Glioblastoma

Date issued: July 2021

For review:  July 2023

Ref: B-286/oncology/LD/Glioblastoma (WHO Grade4) v9

PDF:  Glioblastoma final April 2020 v7.pdf[pdf] 282KB

Following your clinic appointment today with your Consultant Oncologist it has been decided that you will be going ahead with radiotherapy and chemotherapy for the treatment of a Glioblastoma (WHO Grade 4) brain tumour.

The treatment is delivered in 2 stages:

Stage 1

  • 3 or 6 week course of radiotherapy every day Monday to Friday

On the same day as you start radiotherapy you will start a

  • 3 or 6 week course of chemotherapy tablets every day including weekends

The chemotherapy medication is called Temozolomide and your specialist nurse or clinic nurse will give you an information sheet about this medication

  • 3 or 6 week course of an antibiotic starting on day one of your radiotherapy and chemotherapy

The antibiotic medication is called Co- trimoxazole (Septrin) and a prescription will be given to you along with instructions on when to take it by your Consultant Oncologist

  • During your 3 or 6 week course of treatment you will have a weekly blood test at the hospital and the radiographer will advise you as to when and where to go

Please be aware that your Consultant may adjust the treatment plan according to your specific situation.

Before stage 1 of your treatment can start we will need to arrange some appointments that will help with the planning and preparation of your treatment. These will include the following:

Pre Treatment Planning Schedule

  • Height and Weight

  • Pre chemotherapy bloods at the GP surgery

  • Mask appointment

  • CT head scan - used for planning your radiotherapy

  • Verification appointment – radiotherapy planning session

  • Pre chemotherapy chat to include: Safety issues, contact numbers, collection of chemotherapy tablets, antibiotics and anti-sickness medications

  • COVID test

All of these appointment details outlining dates, times and locations will be sent to you in the post.  

Once you have attended the above appointments you will be given a date to start your 3 or 6 week course of treatment as outlined in stage 1

Post Treatment Planning Schedule

On the last day of your 3 or 6 week course of radiotherapy and chemotherapy the radiographer will give you an appointment date to see your Consultant Oncologist in clinic for a post treatment review. 

At this appointment the oncologist or a member of their team in conjunction with you, will then decide about starting stage 2 of the treatment plan.  If you are to go ahead with stage 2 of the treatment plan an appointment will be given to you to attend the chemotherapy unit within the next 3 – 4 weeks.

You will have a post treatment brain scan approximately 10 – 12 weeks after you have completed stage 1 of your treatment (radiotherapy/chemotherapy).  A further brain scan will be requested on completion of stage 2, unless otherwise indicated, at which point your Consultant Oncologist or a member of their team will discuss this with you

Stage 2

Following completion of your 3 or 6 week course of radiotherapy and chemotherapy you will commence chemotherapy cycles. 

This will be the same Temozolomide chemotherapy as you had in stage 1.  However the dose will be increased on cycle 1 and cycle 2 if tolerated.

Each cycle equals 28 days

  •  5 days of Temozolomide

  •  23 days of no Temozolomide

  •  No Antibiotics required in stage 2

  •  Monthly blood test prior to your clinic or hospital review this may be a face to face appointment or a telephone consultation

Prior to each cycle of chemotherapy you will be contacted by your Consultant Oncologist or a member of their team for a review; you will need to have a blood test at your GP surgery in advance of this and your local team will advise you of when this should be done.

Day…………..

If you feel well and your blood results are within the normal ranges for chemotherapy, then you will have up to 6 cycles of Temozolomide.

General notes:

Once you have been allocated your radiotherapy dates and times, your radiotherapy team will be able to advise you as to when and how to take your medications. 

You will also be allocated a patient held record either at your verification or chemotherapy appointment prior to starting treatment, please ensure you bring this along to your oncology appointments.

During stage 1 and 2 of your treatment take any regular medications you are on as per your usual routine.

We use dexamethasone to help with sickness and it is often used during your chemotherapy cycles, it is safe to increase and decrease the dose within this 5 day period.  If you are unsure about your steroid medication please speak with your specialist nurse who will be able to advise you.

Anti – sickness medications: It is recommended that whilst you are taking your chemotherapy medication you take the prescribed anti-sickness medications.  Anti-sickness medications will be prescribed and issued with your chemotherapy tablets.  However please note if you need to take ondansetron for sickness it can cause severe constipation, and you will need to take an aperient.  Please inform a member of the team if this is a problem. If you have problems with sickness, please contact the chemotherapy unit, who will be able to advise/review your medications.

Flu Vaccination is encouraged whilst you are undergoing oncology treatments but please discuss with your Consultant, Specialist Nurse or chemotherapy nurse when the best time would be to have the vaccination. 

COVID vaccination – discuss with your consultant oncologist.

Please read all medication labels carefully, if you are unsure about your chemotherapy medications please contact your Chemotherapy Unit:

As a team we are here to support you, if you have any questions or concerns before, during or after your treatment then please don’t hesitate to speak with your:

  • Specialist Nurse Team

  • Chemotherapy nurse

  • Radiographer                                                     

Planning pre treatment

Height & weight

Pre chemotherapy bloods (GP)

COVID Test

Mask

CT planning scan

Radiotherapy planning session

Pre chemotherapy chat

STAGE 1

3 or 6 weeks Radiotherapy Mon - Fri

3 or 6 weeks Chemotherapy Mon – Sun (everyday)

3 or 6 weeks antibiotics

STAGE 2

Up to 6 Cycles Chemotherapy

Each Cycle

5 days Chemotherapy tablets

23 days of no Chemotherapy tablets

Monthly blood check prior to Chemotherapy cycle

MRI Brain scans after cycle 3 and 6

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