Types of treatment for bone cancer

As with many cancers, the treatment options are surgery, chemotherapy and radiotherapy. Surgery and chemotherapy are the most common treatments for primary bone cancer. Radiotherapy is an important part of treatment for Ewing's sarcoma. Your doctor will plan your treatment taking into account

• The type of bone cancer you have
• How far your cancer has grown or spread (the stage)
• Your general health
• Your age and level of fitness

As with many types of cancer, the earlier your cancer is diagnosed, the easier it is to get it under control and possibly cure it. Some bone cancers are treated with a combination of surgery and chemotherapy, these include

• Osteosarcoma
• Ewing’s sarcoma 
• Spindle cell sarcoma (fibrosarcoma and malignant fibrous histiocytoma) 

For these types of bone cancer, doctors often give chemotherapy before surgery to help shrink the tumour and make it easier to remove.

Children and young adults who have a high grade osteosarcoma may have a biological therapy called mifamurtide (Mepact) alongside chemotherapy after surgery.

Ewing's sarcoma responds well to radiotherapy and this may be used 

• To shrink a tumour after chemotherapy 
• Before or after surgery to help lower the risk of the cancer coming back

You may have radiotherapy as your main treatment instead of surgery if the tumour is difficult to remove surgically. For example, Ewing's sarcoma sometimes develops in the pelvis and it may then be very difficult to remove.

Doctors most often treat chondrosarcomas with surgery. Doctors do not routinely use chemotherapy or radiotherapy to treat this type of bone cancer as these treatments don't work very well, except for a type called dedifferentiated chondrosarcoma. In some situations, your doctor may suggest radiotherapy, either after surgery or to help relieve symptoms.

Chordoma is usually treated with surgery followed by radiotherapy.

The type of surgery you have will depend on the size of the cancer, where it is in your body and whether it has grown into the tissues surrounding the bone. Your surgeon may suggest

• Removing the bone affected by the cancer
• Limb sparing surgery
• Removal of an arm or leg (amputation)
• Surgery to remove cancer that has spread

Removing the bone affected by the cancer

The surgeon removes part or all of the bone affected by the cancer. This is called resection. You may have this type of surgery for cancer in bones such as a rib or fibula (calf bone). The bone is removed along with a surrounding area of healthy tissue. If the cancer is in a bone in an arm or leg this type of surgery is called limb salvage surgery.

Limb sparing surgery

This means surgery to an arm or leg to take out the bit of the bone where the cancer is growing. It is also sometimes called limb salvage surgery. The surgeon replaces the piece of bone containing the cancer with a piece of metal (a prosthesis) or with a bone graft. A graft is a piece of healthy bone from somewhere else in your body. Bone can also be taken from another person. Using bone from another person is called a bone allograft. This type of surgery is very skilled and complicated. It has to be done by specialist surgeons working in specialist centres. You may have to travel to a major treatment centre, rather than go to your local hospital.

Removal of an arm or leg (amputation)

It can be devastating news to be told you must lose an arm or leg. But you may need the operation to try to cure the cancer. Amputation may be needed if the bone tumour has spread into the tissues surrounding the bone. It may be that if your surgeon only removes the tumour, there may be a very high risk of the cancer coming back. Or the tumour may be in a place where the function of the limb would not be very good after limb sparing surgery.

After the surgery, a specialist in false limbs (prosthetic limbs) will fit you with a prosthesis made specially for you. The limb specialist and the specialist physiotherapists will make sure you have all the help you need to learn to cope with your prosthesis. 

Surgery to remove cancer that has spread

Primary bone cancer that has spread can sometimes be removed with surgery. This is called metastatectomy and is most often done with lung secondaries. It can also be used for bone secondaries. This type of surgery is not always possible. It depends on how many secondary cancers there are and their size and shape. Successful removal of lung cancer secondaries is more common after osteosarcoma than other types of primary bone cancer.

Chemotherapy works very well for some types of bone cancers, particularly Ewing's sarcomas and ostesarcomas, but not for all patients. Unfortunately we can't tell how the cancer will respond until you've tried the treatment.

Chemotherapy can help cure your bone cancer. It can be very intensive treatment. There is information about chemotherapy for bone cancer and the specific drugs used in this section.

Chemotherapy is usually used with surgery to treat bone cancer. For Ewing's sarcoma, osteosarcoma and spindle cell sarcomas, you usually have the treatment before and after surgery. The treatment before surgery helps to shrink the cancer and make it easier to remove. It may sometimes make it possible to do limb sparing surgery instead of an amputation. After your chemo treatment, you will have to wait for your blood counts to come back to normal before you have your surgery.

The chemotherapy after surgery is to try to kill off any cancer cells that escaped before your tumour was removed. This lowers the risk of the cancer coming back in the future.

Radiotherapy can be an important part of treatment for Ewing's sarcoma. It can shrink a tumour and make it easier to remove. After surgery, you usually have radiotherapy to try to kill off any cancer cells that may have been left behind. This lowers the risk of the Ewing's sarcoma coming back in the future. If surgery to remove the tumour would be too difficult, radiotherapy and chemotherapy treatment may be used instead.

Radiotherapy is sometimes used after surgery for chordomas.

Doctors occasionally use radiotherapy after surgery for osteosarcomas if there is a risk of cancer cells remaining in the area after the surgery, but it is not a routine treatment.

For osteosarcoma, Ewing’s sarcoma and chordoma radiotherapy may be used to relieve symptoms or treat advanced bone cancers. It can be very good at shrinking cancers in the bones and so relieving pain and other symptoms caused by pressure from the cancer.

Radiotherapy is rarely used to treat chondrosarcoma because it does not usually work very well for this type of bone tumour.