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About chemotherapy for bone cancer

Chemotherapy uses anti cancer or cytotoxic drugs to destroy cancer cells. Some types of bone cancer respond very well to chemotherapy, particularly Ewing’s sarcoma. Doctors often use it for osteosarcoma and spindle cell sarcoma as well.

You will usually have chemotherapy before surgery, to shrink a cancer. And also after surgery to try and stop the cancer coming back. Doctors also use chemotherapy for advanced cancer, to reduce symptoms or to slow the cancer down. This is called palliative treatment.

How you have the treatment

You usually have chemotherapy as a course of several treatments. You have the drugs over several days as an inpatient. You then have a break of 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 – usually at least 6. With some types of chemotherapy you may go into hospital more than once during each treatment cycle.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating bone cancer section.

 

 

What chemotherapy is

Chemotherapy uses anti cancer or cytotoxic drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body.

 

When chemotherapy is used for bone cancer

Chemotherapy works very well for some types of bone cancer, particularly Ewing's sarcoma. Doctors often use chemo for osteosarcomas and spindle cell sarcomas as well. It is used with surgery or radiotherapy. You may have chemotherapy treatment

 

How you have the treatment

You usually have chemotherapy as a course of several treatments. You have the drugs over several days as an inpatient. You then then have a break of 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 – usually at least 6. With some types of chemotherapy you may go into hospital more than once during each treatment cycle.

If you have Ewing's sarcoma, you may have up to 14 cycles of chemotherapy.

How you have your chemotherapy will depend on the particular drug or combination of drugs you are having. You may have a drug

  • As an injection through a small tube going into a vein
  • Through a drip into your arm
  • Through a central line or peripherally inserted central catheter (PICC) line

Central lines and PICC lines are usually used for people having quite an intensive course of chemotherapy. They are tubes put in under a general or local anaesthetic. A central line goes into a large blood vessel in your chest. This diagram shows how this is done

Diagram showing a central line

A PICC line starts off by going into a vein in your arm. These are usually put in under local anaesthetic in the outpatient department. A local anaesthetic cream, such as EMLA, can be put on the skin first, instead of a local anaesthetic injection – this is particularly useful for children.

The main advantage of these lines over a drip is that they stay in throughout your treatment. So you don't have to keep having needles put in for drips. And you can have your blood samples taken from them, so no more needles for that either. The lines have to be kept very clean – and remember you are at increased risk of infection at times during chemotherapy. It is also important that blood does not clot in the tube. The line is flushed regularly with heparin (an anti clotting drug) or salt water (saline) to prevent clotting. 

Some hospitals teach you to look after your own line. Others prefer you to come in to have it cleaned or a district nurse can come to your home to do it. There is more information about central lines and PICC lines in the main chemotherapy section.  And more about chemotherapy drugs for bone cancer on the next page in this section.

 

Chemotherapy before surgery

Many people with primary bone cancer have chemotherapy both before and after surgery – peri operative chemotherapy. Shrinking the cancer before surgery makes it easier for your surgeon to completely remove it. It may mean that it is possible for you to have limb sparing surgery, rather than an amputation.

 

Chemotherapy after surgery

With any cancer, there is a risk of it coming back even though it has been completely removed. Doctors give chemotherapy after surgery to try to reduce this risk. Chemotherapy has significantly improved the cure rates for primary bone cancer – it cures many more people than surgery alone.

You may have chemotherapy even if your surgeon could not remove all of your bone cancer. Chemotherapy might be used to try to shrink the cancer that was left behind after the operation. In this situation, even if the chemotherapy shrinks it completely, there is a high risk of the cancer coming back at some time in the future.

 

Chemotherapy to relieve symptoms

Treatment to control symptoms is called palliative treatment. If you have a bone cancer that cannot be completely removed, your doctor may suggest chemotherapy to try to shrink the cancer, slow it down, or reduce or relieve any symptoms that you have.

 

Clinical trials

You may be asked to take part in a clinical trial. This is because it is important for doctors to find out which treatments work best. As the aim of the treatment is to make you feel better, it is important that the chemotherapy itself does not make you too ill or that you do not have to make too many trips to the hospital. So, research trials also look at the side effects the treatment causes and into new ways of giving treatment. There is information about taking part in a clinical trial in our trials and research section and you can look for trials in primary bone cancer on our clinical trials database. Choose 'bone' from the drop down menu of cancer types.

 

Taking nutritional or herbal supplements with chemotherapy

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed them by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in our complementary therapies section.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.

 

More chemotherapy information

For more information about chemotherapy, look at the main chemotherapy section. It explains the treatment in more detail, including

If you would like more information about chemotherapy, ask your chemotherapy nurse or contact our cancer information nurses. They would be happy to help.

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Updated: 29 May 2013