Treatment

The treatment of bone cancer depends on the size and location of the tumor, whether the cancer has spread, and the patient’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the clinical trials section.

For a low-grade tumor, the primary treatment is surgery. The goal of surgery is to remove the tumor and a margin of healthy bone or tissue around the tumor to make sure all the cancer cells are gone.

For a high-grade tumor, oncologists (a doctor who specializes in the care and treatment of people with cancer) often use a combination of treatments, including surgery, chemotherapy, and radiation therapy.

Descriptions of the most common treatment options for bone cancer are listed below.

Surgery

A surgical oncologist is a doctor who specializes in treating cancer using surgery. Surgery for bone cancer often involves a wide excision of the tumor. A wide excision removes the tumor along with a margin of normal tissue in all directions. Limb-sparing techniques are used whenever possible. However, amputation (removal) of an affected arm or leg may be necessary depending on the tumor’s size or location.

Wide excision surgical techniques have reduced the number of amputations performed for patients with bone cancer. About 75% to 80% of patients can be treated with conservative surgery compared with amputation. These surgeries often require prostheses, such as metal plates or bone from other parts of the body, to replace the missing bone and provide strength to the remaining bone. Learn more about cancer surgery.

For some patients, amputation may offer the best option. These include patients whose cancer is located where it cannot be completely removed by surgery, patients who cannot undergo reconstruction, or when the surgical area cannot be adequately covered with soft tissue. Surgeons use soft tissue, such as muscle, to cover the reconstruction area. The tissue helps in healing and reduces the risk of infection.

Children with bone cancer may require amputation more often than adults since their bones grow more. To avoid amputation, some children can be fitted for expandable joint prostheses that adjust as the skeleton grows. These prostheses require multiple operations to adjust bone length as the child grows.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time. Chemotherapy for bone cancer can usually be given as an outpatient treatment, which is treatment that can be given at a clinic or doctor’s office instead of being admitted to a hospital.

Chemotherapy is often useful for treating cancer that has metastasized. Fast-growing bone cancer may be treated first with chemotherapy before surgery. This often reduces the size of the primary tumor and may destroy tiny areas of metastasis if some of the cancer cells have spread to other areas.

Surgery alone is not usually sufficient treatment for patients with some bone cancers, particularly osteosarcoma. These cancers sometimes recur as distant metastases (most often in the lungs) that were most likely present in a microscopic form when the person was diagnosed. The use of chemotherapy has increased survival rates for some types of bone cancer.

For most high-grade tumors, the oncologist gives chemotherapy for three to four cycles before surgery to shrink the primary tumor, so the tumor is easier to remove. Chemotherapy before surgery may also improve survival, since it may kill cells that have spread from the original tumor. The tumor’s response to chemotherapy, evaluated with a microscope after the primary tumor has been removed, can be used to better determine the prognosis. Chemotherapy that is given before surgery is called preoperative chemotherapy, neoadjuvant chemotherapy, or induction chemotherapy.

After the patient has recovered from surgery, the patient may receive additional chemotherapy to kill any remaining tumor cells. This is called postoperative or adjuvant chemotherapy. The use of chemotherapy to shrink the tumor before surgery combined with chemotherapy after surgery has saved many lives and many patients’ limbs.

Some common chemotherapy drugs given to patients with bone cancer are ifosfamide (Ifex), methotrexate (multiple brand names), cyclophosphamide (Cytoxan, Neosar), etoposide (VePesid, Etopophos, Lastet), cisplatin (Platinol), doxorubicin (Adriamycin), and dactinomycin (Actinomycin-D, Cosmegen, Lyovac Cosmegen).

In particular, Ewing’s sarcoma responds well to chemotherapy. Some drugs used to treat Ewing’s sarcoma are vincristine (Oncovin), dactinomycin, cyclophosphamide, doxorubicin, ifosfamide, and etoposide.

The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.

For bone cancer, radiation therapy is most often used for patients with a tumor that cannot be removed by surgery or that may have cancer cells remaining after surgery. Radiation therapy may be done before surgery to shrink the tumor, or it may be done after surgery to eliminate any cancer cells remaining after surgery. Radiation therapy makes it possible to do less extensive surgery, often preserving the arm or leg. Radiation therapy may also be used to alleviate pain in advanced bone cancer.

For patients with Ewing’s sarcoma, radiation therapy may be used with chemotherapy and surgery. However, oncologists have had good results in recent years using surgery for Ewing’s sarcoma, with or without radiation therapy. Ewing’s sarcoma that starts in bones that cannot be surgically removed is treated with chemotherapy and radiation therapy.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about radiation therapy.

Find out more about common terms used during cancer treatment.