Bone Cancer Treatment
Bone cancer treatment depends on the type of cancer. For most people with osteosarcoma or Ewing sarcoma, chemotherapy and surgery are the main treatments and are usually used together. For chondrosarcoma, surgery is the most common treatment. Other options like radiation therapy, proton therapy or targeted therapy may be used in certain situations. Your care team will create a treatment plan that¡¯s personalized to your type of bone cancer, the location and stage of the tumor, and your overall health.
Surgery
Surgery is the main treatment for most bone cancers. Both the biopsy and surgery should be performed by a surgeon with extensive experience in bone tumors and limb-sparing techniques. A poorly placed biopsy can complicate surgery and reduce the chances of complete tumor removal.
Whenever possible, the same surgeon performs both the biopsy and the definitive surgery, allowing precise planning and positioning for tumor removal.
Types of bone cancer surgery
- Wide-excision surgery: The surgeon removes the tumor along with some surrounding healthy tissue to minimize the risk of leaving behind cancer cells
- Limb-sparing surgery: For tumors in an arm or leg, surgeons aim to remove cancer while preserving the limb. Bone may be replaced with a bone graft or an endoprosthesis (internal device)
- Amputation: If limb-sparing surgery is not feasible, amputation may be necessary. Patients will receive reconstructive surgery or a prosthesis, followed by rehabilitation to regain mobility and function
Recovery:
Surgery is performed under general anesthesia, and patients may need to stay in the hospital anywhere from several days to a few weeks, depending on the complexity of the procedure. Early recovery focuses on wound healing, pain management and beginning gentle movement with the help of the care team. Physical therapy continues after discharge, either as an inpatient or outpatient, and plays a key role in regaining mobility and adapting to changes such as prosthesis use.
Recovery times vary based on tumor size, location and type of surgery, but ongoing support is provided to help patients return to daily activities as safely and fully as possible.
Chemotherapy
Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing.
Patients can get chemotherapy intravenously or orally, usually in cycles over several weeks. It is most commonly used for osteosarcoma and Ewing¡¯s sarcoma, particularly in children and young adults. For osteosarcoma and Ewing sarcoma, chemotherapy is often given before surgery to shrink the tumor and after surgery to kill remaining cancer cells. Chemotherapy is also used when cancer has spread to the lungs or other organs.
The side effects of chemotherapy depend on the exact drug the patient gets. They can include nausea, fatigue, hair loss or lowered immunity.
Learn more about chemotherapy and chemotherapy side effects.
Radiation therapy
Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue.
Bone cancer is generally less sensitive to radiation than some other tumor types. Surgery is the best first option to remove a primary bone sarcoma. However, radiation therapy can be effective at high doses using some specialized techniques, so Radiation therapy is sometimes considered as an alternative to surgery. It is also recommended if the tumor cannot be completely removed surgically, if some cancer cells remain after surgery, or if the goal is to relieve pain or other symptoms from bone metastases.
Radiation is typically delivered in multiple short sessions, and side effects depend on tumor location.
Learn more about radiation therapy
Proton therapy
Proton therapy is a type of radiation therapy. It is similar to standard radiation therapy, but it uses a different type of energy that may allow doctors to target tumors with much more accuracy. This limits damage to nearby healthy tissue and allows for the delivery of a more powerful dose of radiation. The MD Anderson Proton Therapy Center is one of the largest and most advanced centers in the world.
Patients with bone cancer who receive proton therapy typically have treatments in outpatient sessions over several weeks. Side effects of proton therapy are generally mild but can vary depending on the tumor¡¯s size and location. Common side effects may include skin irritation, fatigue, and temporary soreness in the treated area. If the tumor is located near critical structures (such as the spine, pelvis, or head and neck), side effects may differ, and your care team will discuss what to expect in your specific case.
Learn more about proton therapy
Targeted therapy
Targeted therapy drugs are designed to stop or slow the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them.
For bone cancers, targeted therapies may be given as pills or through an intravenous (IV) line. When given by IV, targeted therapy sessions usually take about 30 minutes to a few hours, depending on the specific drug. Treatment schedules vary¡ªsome medicines are given once every few weeks, while others may be taken daily as pills for several months. The exact plan depends on the type of bone cancer, the drug being used, and how well the treatment is working.
Side effects of targeted therapy vary by medication but are usually more limited than those from traditional chemotherapy. They often relate to how the drug works or where it acts in the body¡ªfor example, skin changes, diarrhea or high blood pressure. Your care team will review the possible effects of your treatment and help manage them if they occur.
Learn more about targeted therapy and targeted therapy side effects.
Chordoma survivor: 'Put your faith in the doctors'
¡°I was very lucky to go to MD Anderson,¡± says Chuck Schlesinger.
In early 2015, Chuck was playing tennis when he felt a sharp pain in his neck. Thinking it was a sports-related injury, he went to a local specialist north of Houston to get it checked out. But X-rays revealed a tumor.
The tumor sat in Chuck¡¯s cervical spine, nestled among the bones of his neck. Given the tumor¡¯s location in the delicate cervical vertebrae, his doctor didn¡¯t believe a biopsy was possible. Instead, the doctor recommended doing a biopsy during a very invasive surgery.
¡°They said they¡¯d have to split my jaw and go through the back of my throat,¡± says Chuck, who was 62 at the time. Then, he would need chemotherapy and radiation therapy.
Chuck thought that procedure sounded extreme. He worried it would leave him disabled and change his life forever.
He called a friend, who told him, ¡°Chuck, you need to get a second opinion at MD Anderson.¡±
Second opinion leads to non-invasive procedure
Chuck soon met with neurosurgeon and spine specialist , who told him MD Anderson could do a biopsy as a quick outpatient procedure.
¡°That¡¯s when they found out it was chordoma,¡± says Chuck. This very rare tumor is diagnosed in only 300 to 600 people a year in the United States.
Instead of an invasive surgery, Tatsui recommended stereotactic radiation (SRS), an outpatient procedure offered at MD Anderson. Doctors use radiation to target the tumor with extreme accuracy, protecting the surrounding tissues. Patients are fitted with a mesh frame to wear during the procedure to help them stay still.
In May 2015, Tatsui and radiation oncologist , performed the SRS procedure at MD Anderson¡¯s Texas Medical Center Campus. ¡°It only took 30 minutes,¡± Chuck remembers.
And, how was his recovery? ¡°I had no aftereffects, no pain,¡± he says. What¡¯s more, Chuck needed only one SRS session. ¡°The radiation was a one-shot deal.¡±
Stabilization surgery improves patient quality of life
For several months, Chuck remained on surveillance. Tatsui sent him for regular MRIs at MD Anderson The Woodlands, close to his home. The MRIs showed the tumor was shrinking.
Six months after Chuck completed SRS, Tatsui suggested a surgical procedure to stabilize his cervical spine. ¡°He felt that the bone might have deteriorated, so he put some pins in it,¡± says Chuck.?
Chuck was a little concerned.
¡°I had never had surgery like that before,¡± he says. ¡°I was a little nervous because he had to go in my neck.¡±
But the procedure was a success. ¡°I didn¡¯t have any pain,¡± Chuck noted. And, with some physical therapy, he maintained normal function.
Immunotherapy at MD Anderson treats tumor
Chuck continued regular MRI surveillance and follow-up appointments with Tatsui every six months, then yearly. Seven years after his radiation treatment, MRIs revealed that the chordoma was growing again.
Tatsui consulted with MD Anderson sarcoma oncologist Conley recommended an immunotherapy drug called pembrolizumab, which trains the immune system to recognize and attack cancer.
¡°Most drugs for chordoma either don¡¯t work or have very limited benefit,¡± says Conley. But Chuck, who has been taking pembrolizumab since the summer of 2022, remains stable.?
He has had nearly two dozen infusions so far. Every six weeks, he receives an infusion at MD Anderson The Woodlands. ¡°It¡¯s very convenient,¡± he says of the location. ¡°They can do bloodwork, MRIs and CT scans.¡± Parking is easy, too, he says: ¡°You drive in, and there¡¯s a space. The parking lot is never full.¡±
The infusion takes 30 minutes. ¡°I¡¯m in and out in two hours,¡± Chuck says. He gets his infusions first thing in the morning and then goes about his day. ¡°I could play tennis the same day, but I don¡¯t!¡± he laughs.
A 10-year relationship with MD Anderson and its people
Every few infusions, Chuck travels to MD Anderson¡¯s Texas Medical Center Campus to meet with Conley. And every four months, he gets an MRI and reviews the results with Tatsui. The results are promising.
¡°We started seeing that the tumor was shrinking,¡± Chuck says. So far, there is no indication of tumor recurrence, and his doctors believe he is stable.
¡°I was very lucky to go to MD Anderson,¡± Chuck says. "If I had gone to another major hospital, my life would be totally changed.¡± He is grateful for MD Anderson¡¯s careful approach to his care. ¡°We¡¯re going on 10 years, and Dr. Tatsui thinks the tumor is inactive. My treatment was literally lifesaving.¡±
The people at MD Anderson make the difference for Chuck. ¡°Everybody is so helpful and friendly,¡± he says. ¡°When I go in for an MRI, they remember the type of music I like.¡±
So, what would he tell another patient? ¡°Put your faith in the doctors. They know what they¡¯re doing, and they care very much about the outcomes.¡±
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