Bone Cancer

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Bone Cancer Treatment

Treatment for bone cancer depends on the stage and location of the disease, and on the patient's age and general health. Treatment may include surgery, chemotherapy, and radiation therapy, and in many cases, a combination of treatments is used.

Biologic therapy, also called biotherapy or immunotherapy, which may help to restore the body's natural defenses against cancer, is being studied as a possible treatment for localized primary bone cancer.

Surgery
Patients who have localized bone cancer are treated surgically whenever possible. In some cases, the surgeon is able to remove just the tumor and some surrounding healthy tissue (called limb-sparing surgery), but in other cases, the entire limb or part of the limb must be removed (called amputation). If bone cancer has spread to the lymph nodes, a lymph node dissection also is performed.

In some cases following surgery to treat bone cancer, an artificial device or a bone from another area of the body may be used to replace bone tissue that was removed. This procedure is called reconstructive surgery.

Chemotherapy
Chemotherapy is a systemic treatment (i.e., travels throughout the body via the bloodstream) that uses drugs to destroy cancer cells. Some chemotherapy drugs are administered orally (in pill form) and others are administered through a needle into a vein (intravenous) or injected into muscle. In many cases, more than one drug is used (called combination chemotherapy).

To treat bone cancer, chemotherapy is often used following surgery to destroy cancer cells that may remain after removal of the tumor (called adjuvant treatment). In some cases, chemotherapy is administered prior to surgery in order to shrink the tumor (called neoadjuvant treatment).

Chemotherapy drugs commonly used to treat bone cancer include the following:

• Actinomycin-D (e.g., Dactinomycin®, Cosmegen®)
• Cisplatin (e.g., Platinol®)
• Cyclophosphamide (e.g., Neosar®)
• Doxorubicin (e.g., Adriamycin®, Doxil®)
• Etoposide (e.g., VP-16, Toposar®, Vepesid®)
• Gemcitabine (e.g., Gemzar®)
• Ifosfamide (e.g., Ifex®)
• Methotrexate (e.g., Trexall®, Methotrex®)
• Vinblastine (e.g., Velban®)
• Vincristine (e.g., Oncovin®, Vincasar®)

For some types of bone cancer (e.g., Ewing's tumor) an intense regime of chemotherapy (called myeloablative treatment) with stem cell support may be used. In this treatment, chemotherapy drugs are used to destroy rapidly dividing cells throughout the body (e.g., cancer cells, certain blood cells) and the patient receives supplemental stem cells (cells found in bone marrow and lymphatic tissue that create other types of blood cells).

Chemotherapy may cause a number of serious side effects, including the following:

• Anemia (reduced red blood cell count)
• Fever
• Hair loss
• Infection
• Nausea and vomiting
• Reduced blood cell counts (e.g., leukopenia, thrombocytopenia)
• Sterility

Radiation Therapy
Radiation therapy uses high-energy x-rays to destroy cancer cells. To treat bone cancer, a machine outside the body is used to direct this energy to the treatment area (called external radiation). Side effects of radiation include fatigue and changes to the skin (e.g., redness, irritation).

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