Chemotherapy treatment for bone cancer
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
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.
When you have chemotherapy
Chemotherapy works very well for some types of bone cancer, particularly Ewing 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 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.
You might have chemotherapy for bone cancer as part of a clinical trial. Researchers are interested in the side effects that treatment for bone cancer causes and new ways of giving treatment.
How you have chemotherapy
You have the treatment through a drip into your arm or hand. 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.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take newspapers, books or electronic devices to help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for 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
The most common chemotherapy regimes used to treat Ewing 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. 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:
- cisplatin through a drip into your cannula or central line
- doxorubicin through a drip into your cannula or central line
- cisplatin through a drip into your cannula or central line
- doxorubicin through a drip into your cannula or central line
- high dose methotrexate through a drip into your cannula or central line
- folinic acid through a drip - to help control side effects
- 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.
Before you start chemotherapy
COVID swab test
Due to coronavirus, you need to have a test to check for coronavirus before you have treatment. The test is called a COVID swab test.
To have the test your nurse takes a sample from the inside of your nose and the back of your throat. They use a long cotton bud to take the sample. Or the sample might be saliva or other fluid. Depending on which test your hospital uses, it can take from 90 minutes to a few days to get a result.
At most hospitals, you have a COVID swab test 48 to 72 hours (up to 3 days) before going for your treatment in the chemotherapy unit.
This means you might have the swab test on the same day that you visit the hospital for blood tests and your doctor’s clinic appointment. If you have treatment weekly or more often, some hospitals will ask you to have the swab test on the day of treatment.
Check with your team about when you’ll have the test as there are some differences between hospitals.
Blood tests
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
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 a few days or so. Your treatment team can help to manage any side effects that you have.
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.
