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Chemotherapy treatment

When, where and how you have chemotherapy for primary bone cancer, and the possible side effects.

This page is about cancer that starts in your bone (primary bone cancer).

If your cancer has spread into bone from another part of the body, it is called secondary or metastatic bone cancer.

What chemotherapy is

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

Why you have it

Chemotherapy works very well for some types of bone cancer, particularly Ewing's sarcoma. You often have chemotherapy for osteosarcoma or spindle cell sarcoma as well. There are different reasons why you might have chemotherapy treatment.

This is to try and shrink the cancer before surgery. This makes it easier for your surgeon to completely remove it. It might mean it is possible for you to have limb sparing surgery, rather than an amputation.

You might have chemotherapy after surgery to try to reduce the risk of the cancer coming back.

Or you might have chemotherapy if your surgeon could not remove all of the bone tumour. Chemotherapy can shrink cancer that has been left behind. But even if chemotherapy shrinks it completely there is a high risk of it coming back some time in the future.

You might have chemotherapy with radiotherapy if you have Ewing's sarcoma that can't be completely removed with surgery.

Some children and young adults with osteosarcoma might have chemotherapy with a type of targeted cancer drug called mifamurtide. This isn't a common treatment. You might have this cancer drug as part of a clinical trial.

Treatment to control symptoms is called palliative treatment. You might have palliative chemotherapy to try and shrink the cancer, slow it down and relieve any symptoms that you have.

Clinical trials

You might have chemotherapy for bone cancer as part of a clinical trial. Resarchers are interested in the side effects that treatment for bone cancer causes and new ways of giving treatment.

Types of chemotherapy

There are many different drugs to treat bone cancer. You usually have a combination of drugs. 

Some of the common chemotherapy drugs for bone cancer are:

  • vincristine
  • ifosfamide
  • doxorubicin (Adriamycin)
  • etoposide
  • methotrexate
  • cisplatin
  • cyclophosphamide

Where and when you have chemotherapy

Your treatment plan is called your chemotherapy regimen. The regimen includes the names of your drugs, when you should have them, and the dose you have. You have different regimens for different types of bone cancer. 

You usually have the chemotherapy drugs over several days as an inpatient in the hospital. You then have a break for a couple of weeks. This makes up one cycle of treatment.

You then start another cycle. 

A whole course of treatment is made up of a number of cycles. You normally have between 6 and 14 cycles of treatment.

The most common chemotherapy regimes used to treat Ewing's sarcoma are:

  • VIDE (vincristine, ifosfamide, doxorubicin (adriamycin) and etoposide)
  • VIA (vincristine, ifosfamide and actinomycin D)
  • VAC (vincristine, actinomycin D and cyclophosphamide)

High dose chemotherapy with stem cells

You might have more intensive treatment as part of a clinical trial. This is called high dose chemotherapy with stem cell rescue or stem cell transplant. You have this treatment if there is a high risk of your cancer coming back.

You have stem cells collected and stored until after your high dose chemotherapy. You then have the cells back into a vein so they can start to make new blood cells again.

There are different combinations of drugs for osteosarcoma. Doctors often use a chemotherapy regimen which lasts 5 weeks. This involves:

Day 1 (week 1)
  • cisplatin through a drip into your cannula or central line
  • doxorubicin through a drip into your cannula or central line
Day 2 (week 1)
  • cisplatin through a drip into your cannula or central line
  • doxorubicin through a drip into your cannula or central line
Day 22 (Week 4)
  • high dose methotrexate through a drip into your cannula or central line
  • folinic acid through a drip - to help control side effects
Day 29 (Week 5)
  • high dose methotrexate through a drip into your cannula or central line
  • folinic acid through a drip - to help control side effects

You have fluids before, alongside and after the chemotherapy. You also need frequent blood tests while you are having high dose methotrexate.

You are likely to have a similar treatment to those used for osteosarcoma. The dose might be reduced for older people.

If your osteosarcoma comes back after initial treatment you are likely to have treatment with:

  • ifosfamide and etoposide
  • docetaxel and gemcitabine

If your Ewing's sarcoma comes back after treatment you are likely to have treatment with:

  • ifosfamide
  • etoposide
  • irinotecan and temozolamide
  • cyclophosphamide and topotecan

You might have other chemotherapy drugs which might not be typically given for bone cancer, for example carboplatin.

How you have chemotherapy

You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Diagram showing a central line

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

You might have a hearing test. You also might have an echocardiogram (ECHO) to check your heart function.

After each chemotherapy

After each chemotherapy treatment you usually have a break of a few weeks before you start the next cycle of chemotherapy. During your weeks off, your bone marrow replaces your blood cells. If your white cell count is slow to pick up or you are having intensive treatment, you may have drugs called growth factors. These help your bone marrow make blood cells more quickly.

You usually have growth factors as small injections just under the skin (subcutaneous injections). You usually have a type of growth factor called G-CSF.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have any signs of infection such as a temperature higher than 38C or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

Most side effects only last for the few days that you’re having the chemotherapy drugs. Your treatment team can help to reduce your side effects.

When you go home

Chemotherapy for bone cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you take any supplements or if you have been prescribed anything by alternative or complementary therapy practitioners.

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. They could be harmful.

Last reviewed: 
11 Dec 2017
  • UK guidelines for the management of bone sarcomas
    C Gerrand and others
    Clinical Sarcoma Research, 2016. Volume 6

  • Bone sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up
    The ESMO/European Sarcoma Network Working Group
    Annals of Oncology, 2014. Volume 25, Supplement 3

  • Improving outcomes for people with sarcoma
    National Institute of Health and Care Excellence (NICE), 2006

  • Cancer and its Management (7th edition)
    J Tobias and D Hochhauser
    Wiley-Blackwell, 2015

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