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If you have any concerns regarding your follow up care please do not hesitate to contact your specialist nurse or chemotherapy/radiotherapy centre for advice.

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.

Stage 1

On the same day as you start radiotherapy you will start a combination chemotherapy treatment. The chemotherapy tablets are called Temozolomide and Lomustine and your specialist nurse or clinic nurse will give you an information sheet about this medication.

• Alongside your 6-week course of radiotherapy, you will take Lomustine on the 1^st day of radiotherapy treatment and Temozolomide on days 2-6.

• During your 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 6-week course of treatment as outlined in stage 1

Post Treatment Planning Schedule

On the last day of your 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). 

Stage 2 

Following completion of your 6-week course of radiotherapy and chemotherapy you will commence chemotherapy cycles.   This will be the same Temozolomide and Lomustine chemotherapy as you had in stage 1.  However, the dose will be increased on subsequent cycles if tolerated.

Each cycle equals 42 days 

• Day 1 day: Lomustine. 

• Day 2-6: Temozolomide

• Blood tests are required on day 21 and day 42 of each cycle

• You will have a clinic review before each new cycle which may be face to face or video clinic.

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 and Lomustine.

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 

• Weekly Blood check

Stage 1 Cycle 1 (6-weeks radiotherapy, chemotherapy, Temozolomide and Lomustine)     

Blood test during radiotherapy and

chemotherapy will be undertaken ……………………