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Radiotherapy for bone cancer

Radiotherapy uses high energy waves to treat cancer. You may have it to shrink bone cancer before surgery, and to lower the risk of it coming back afterwards. Doctors also use radiotherapy to treat bone cancers that cannot be removed because of their location in the body.

It can slow tumour growth and control the symptoms of advanced cancers (palliative radiotherapy).

Having your radiotherapy

You have this treatment in the radiotherapy department at your cancer centre. You usually have treatment every day from Monday to Friday, with a break at weekends. A course of treatment can last for a few days or a few weeks. Each treatment takes only a few minutes.

Radiotherapy for symptoms (palliative radiotherapy) is usually given in 1 to 5 treatment sessions.

What are the side effects?

Radiotherapy usually causes tiredness, reddening of the skin in the treatment area, and loss of hair in the treatment area. Other side effects depend on which part of your body is being treated. Palliative radiotherapy does not usually cause many side effects.

 

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

 

 

Radiotherapy for primary bone cancer

Radiotherapy uses high energy X-rays to treat cancer. For primary bone cancer, you may have radiotherapy to

  • Treat a bone cancer that cannot be removed because of its position in your body
  • Shrink Ewing's sarcoma before surgery
  • Lower the risk of the cancer coming back after surgery
  • Shrink bone cancers that are not responding well to chemotherapy

If a bone cancer grows in the central area of the body, it may not be possible to remove it completely. You may have treatment with a combination of surgery and radiotherapy or with radiotherapy alone.

Shrinking a cancer with radiotherapy before surgery can make it easier to remove. You may be able to have a smaller operation. If your doctors think there is a risk that cancer cells may have been left behind after your operation, they may recommend radiotherapy to kill off any remaining cancer cells.

If your cancer has spread or come back after it was first treated, it may not be possible to get rid of it completely. But it may be possible for your doctor to control the growth of the cancer for a while with radiotherapy and chemotherapy.

You may have palliative radiotherapy to

  • Shrink secondary cancers
  • Try to control the growth of advanced cancer
  • Relieve symptoms the bone cancer is causing.

A growing cancer can cause symptoms by pressing on nerves and other body tissues. Secondary bone cancers can be painful. Fortunately, radiotherapy can often shrink them and so relieve the pressure. Radiotherapy can help to strengthen bones weakened by cancer. After the treatment has killed off the cancer cells, the holes in the bone caused by the cancer are repaired by the osteoblasts – the cells in the bones that make the bone framework.

 

When and where you have radiotherapy

You have radiotherapy treatment in the hospital radiotherapy department at your cancer centre. You cannot have all the radiation you need to kill your cancer in one go. That would cause too many side effects and too much damage to normal body tissue. You have the treatment broken up into a course of smaller dose treatments called fractions. You usually have a fraction every day, from Monday to Friday, with a rest at the weekend.

Most commonly, you have radiotherapy once daily, for a few weeks or days. For Ewing's sarcoma you might have a course of radiotherapy and a course of chemotherapy at the same time. This is sometimes called concurrent chemoradiotherapy. With this type of treatment, you may have radiotherapy treatments twice a day. This is called hyperfractionated radiotherapy. So you might have radiotherapy twice a day for the first two weeks. Then a week with no radiotherapy. And then another 7 days of radiotherapy starting with the next cycle of chemotherapy.

Radiotherapy doses are measured in Grays. It is usually written Gy. For example, a treatment fraction of 2Gy every day for 30 treatments would give a total dose of 60Gy

 

Planning radiotherapy

Before you begin your treatment, the radiotherapy team carefully plan your external beam radiotherapy. This means working out how much radiation you need to treat the cancer and exactly where you need it. Your planning appointment may take from 15 minutes up to a couple of hours. You will have a planning CT scan. The scan shows the cancer and the structures around it.

The 360° photo is of a CT scanner. Use the arrows to look around the room.

You lie on the scanner couch with the treatment area exposed. The radiographers will put some markers on your skin. You need to lie very still. Once you are in position the radiographers move the couch up and through the scanner. The scanner is a doughnut shape. The radiographers leave the room and the scan starts. It takes up to 5 minutes. You won't feel anything. The radiographers watch from the next door room.

Before the planning appointment you may also have other scans, such as MRI scans or PET scans. Your treatment team can feed the other scans into the planning scanner.

Ink marks

Once the treatment team has planned your radiotherapy, they may put ink marks on your skin to make sure they treat exactly the same area every day. They may also make pin point sized tattoo marks in these areas. We have information about radiotherapy skin markings.

Moulds or masks

If you are having treatment to your arm or leg, you may need to have a mould (shell) made to keep the treatment area perfectly still while you have treatment. The moulds are made in the mould room. We have information about making radiotherapy moulds.

After your planning session

You may have to wait a few days or up to 2 weeks before you start treatment. During this time the physicists and your radiotherapy doctor decide the final details of your plan. Your doctor will plan the areas that need treatment and outline areas to limit the dose to or avoid completely. They call this contouring. Then the physicists and staff called dosimetrists plan the treatment very precisely using advanced computers.

 

Having your radiotherapy

Radiotherapy machines are very big. The machine may be fixed in one position or able to rotate around your body to give treatment from different directions. Before your first treatment your radiographers will explain what you will see and hear. The treatment rooms usually have docks for you to plug in music players. So you can listen to your own music.

You can't feel radiotherapy when you actually have the treatment. It takes anything from 1 minute to several minutes. It is important to lie in the same position each time, so the radiographers may take a little while to get you ready.

A photo of a linear accelerator, which gives radiotherapy

Once you are in the right position the staff leave you alone in the room for a few minutes. They watch you carefully through a window or on a closed circuit television screen. They may ask you to hold your breath or take shallow breaths during the treatment.

Our page about having external radiotherapy has a video about having radiotherapy that you may want to watch. 

Having external radiotherapy does not make you radioactive. It is perfectly safe to be with other people, including children, throughout your treatment course.

 

Possible side effects

Radiotherapy has general side effects. It usually causes

  • Tiredness
  • Reddening of the skin in the treatment area
  • Loss of any body hair in the treatment area

Radiotherapy can cause tiredness for many people. The tiredness wears off over the few weeks following your treatment. Other side effects depend on which part of your body is being treated. For example, you may feel sick and lose your appetite if the area being treated is anywhere near your stomach. We have detailed information about radiotherapy side effects for different areas of the body

 

More information about radiotherapy

Look at the main radiotherapy section. It tells you more about this type of treatment including

We have detailed information about bone cancer treatments in this section.

If you would like more information about any aspect of bone cancer, you can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.

Our bone cancer organisations page gives details of other people who can provide information about bone cancer and its treatment. Some organisations can put you in touch with a cancer support group. They often have free factsheets and information which they can send to you. There are also books, booklets, CDs and other resources available about bone cancer. Some of these are free. Look at our bone cancer reading list for details.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 20 August 2014