The primary treatment options for bone cancer include surgery, chemotherapy and radiation therapy. The type of treatment you receive will depend on several considerations, such as the grade, type and size of your bone cancer, where it is located within your body, your medical history and your individual treatment preferences. This page aims to give you a comprehensive overview of how bone cancer treatment works in the private health system.
Surgery for bone cancerSurgery
Surgery is a common treatment option for bone cancer. Depending on where the tumour is located, surgery is typically performed to remove the tumour and some of the healthy tissue surrounding it.
Usually, the tumour will be removed in a single piece along with a section of surrounding healthy tissue. The removed bone may be replaced with bone from another area of your body, donor bone or an alternative replacement made of plastic or metal.
In cases where tumours are very large or located in a complicated area, partial or complete amputation (removal of a limb) may be required. However, amputation is becoming a less common practice with the development of modern treatment options. Types of surgery that may be performed as a form of treatment for bone cancer include:
The goal in limb-salvaging surgery is to remove all the cancer and some surrounding tissue while leaving the limb intact.
All or part of an arm or leg is removed in an amputation along with the cancerous tumours.
Curettage is also referred to as intralesional excision and includes scraping out the tumour without removing any sections of bone. A small hole is left in the bone which is then filled in with bone cement.
Radiation therapy for bone cancer Radiation therapy
Patients who have radiation therapy for bone cancer will receive external beam radiation treatment before or after surgery. It can be used before surgery to help shrink the tumour or after surgery to destroy any remaining cancer cells. It can also be used to help ease symptoms of bone cancer when it has spread (known as palliative radiation).
Radiation therapy may also be used to treat bone cancers in people where surgery is not suitable, for example in areas of the body where it is difficult to treat or in people who are not healthy enough to have surgery.
Stereotactic radiation therapy
Stereotactic radiation therapy is used to treat metastatic tumours that have spread from other organs in the body to the vertebrae in the spine. Your oncologist will use both your MRI scan and planning CT scan to a very high level of accuracy.
Given the proximity of the vertebrae bodies to the spinal cord, we use highly specialised immobilisation devices – ensuring patients remain in the exact same position, state-of-the-art delivery techniques and pre-treatment CT scans to ensure that treatment every day is pinpoint accurate.
Stereotactic radiation therapy can be used to treat tumours that have spread to other bones within the body. Depending on which bone we are looking to treat, your oncologist and radiation therapists will develop and customise a treatment technique that is personalised to your needs.
Chemotherapy for bone cancerChemotherapy
Chemotherapy uses a range of drugs to destroy and slow the growth of bone cancer cells. The type of drug you receive will vary based on the type of your bone cancer. Chemotherapy may be used to treat some types of bone cancer and is especially effective for treating osteosarcoma and Ewing sarcoma. Chemotherapy is usually used before or after surgery and may also be used as a form of palliative treatment for advanced bone cancer.
Chemotherapy treatment takes place over several sessions, known as a cycle. Your care team will walk you through how many cycles you may need for your course of treatment, with most people completing chemotherapy in a period of three to six months.
Common chemotherapy medicines
There are several chemotherapy drugs that are used to treat bone cancer.
The combination of doxorubicin, methotrexate and cisplatin, known as MAP, is often used to treat osteosarcoma. This may be used before surgery to help shrink cancer cells or after surgery to destroy any remaining cancer cells and prevent bone cancer from returning. MAP is usually given by intravenous infusion every four to five weeks.
This chemotherapy drug destroys cancer cells or stops their growth by interfering with the way that DNA is made within cells. It is given by an intravenous infusion and is bright red in colour.
This type of chemotherapy drug is a platinum compound that works by binding to and damaging DNA within cancer cells, preventing them from being able to divide and grow.
This is an antimetabolite chemotherapy drug that interferes with cancer cells’ ability to use folic acid, which they need to produce DNA and survive. After 24 hours, treatment with methotrexate is usually followed with a drug called calcium leucovorin (also called calcium folinate) which limits potential damage to non-cancerous cells.
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Bone cancer is usually treated through a combination of treatment options and treatment plans will vary based on the location and type of cancer you have.
Low-grade chondrosarcoma that is confined to the leg or arm bone is typically treated with surgery. As the cancer is confined to one area, you will likely only need a curettage procedure. However, low-grade chondrosarcomas in other bones and high-grade chondrosarcomas usually require more extensive surgeries like limb-salvage or amputation. Chondrosarcomas in the skull are considered very hard to treat without causing serious side effects, however curettage may be an option for low-grade tumours. Intensity-modulated radiation therapy (IMRT) treatment may be used to treat tumours that cannot be fully removed with surgery. Chondrosarcoma cells are difficult to destroy using radiation alone, so high dose radiation therapy is needed. Chemotherapy is rarely used to treat chondrosarcoma. However, it may be used for some types of chondrosarcomas including dedifferentiated chondrosarcoma and mesenchymal chondrosarcoma.
Undifferentiated pleomorphic sarcoma (UPS)
The first treatment option for UPS is usually chemotherapy to shrink the tumour/s and destroy any cancer cells that have begun to spread. Surgery is then performed to remove the tumour and a section of surrounding healthy tissue. Removed bone will be replaced with bone grafts or prothesis. Some bone cancer patients may receive another cycle of chemotherapy after surgery.
Giant cell tumour of bone
While giant cell tumours do not usually spread throughout the body, they can be hard to remove completely. Treatment usually starts with curettage, followed by chemical or extremely cold treatments to kill remaining cancer cells. In cases where tumours cannot be treated with curettage, limb-sparing surgery or amputation will likely be needed. However, radiation or chemotherapy may be used first to try to shrink the tumour.
Although chordoma tumours are rare, they are most likely to occur in the base of the skull or in lower vertebrae. Chordoma’s are slow growing and unlikely to spread, however due to their location they are very hard to remove fully. The most common treatment for a chordoma is surgery, but radiation therapy may be recommended to decrease chances of recurrence.
- American Cancer Society. (2018, February 5). Surgery for bone cancer. American Cancer Society. Retrieved December 20, 2021, from www.cancer.org/cancer/bone-cancer/treating/surgery.html
- American Cancer Society. (2018, February 5). Treating Specific Types of Bone Cancer. Retrieved December 20, 2021, from cancer.org/cancer/bone-cancer/treating/treating-specific-bone-cancers.html
- Cancer Council. (2019, June). Bone cancer: Causes, symptoms &; treatments. Cancer Council. Retrieved December 20, 2021, from cancer.org.au/cancer-information/types-of-cancer/bone-cancer
- American Cancer Society. (2018, February 5). Early Detection, Diagnosis, and Staging: Bone cancer stages. Retrieved December 20, 2021, from cancer.org/cancer/bone-cancer/detection-diagnosis-staging/staging.html
- Cancer Institute of NSW. eviQ. (2018, June).Medical Oncology. Osteosarcoma MAP (methotrexate, DOXOrubicin, ciSplatin). Retrieved January 20, 2022 from https://www.eviq.org.au/medical-oncology/sarcoma/bone-sarcoma/1901-osteosarcoma-map-methotrexate-doxorubicin
- Yu, Michael H, MD, ScM, Hoffe, Sarah E, MD. UpToDate. (2021, August). Overview of therapeutic approaches for adult patients with bone metastasis from solid tumors. Last retrieved January 20, 2022 from https://www.uptodate.com/contents/overview-of-therapeutic-approaches-for-adult-patients-with-bone-metastasis-from-solid-tumors
- ESMO Guidelines for Patients. Bone Sarcoma. (2016). European Society for Medical Oncology. Last retrieved January 20, 2022 from https://www.esmo.org/for-patients/patient-guides/bone-sarcoma
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