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Treatment for primary bone cancers can include surgery, chemotherapy (treatment with drugs that kill cancer cells), or radiation therapy, alone or in combination. The type of treatment used depends on the type, location, and size of the tumor, as well as the patient's age and general health.
Surgery
Surgery is often the primary treatment for bone cancer. When operating to remove bone tumors, surgeons remove some of the surrounding bone and muscle to be sure that they are removing as much cancerous tissue as possible. If the operation is on an arm or leg, the surgeon will try to preserve the limb and maintain its functionality. Sometimes the bone that is removed will be replaced with bone from another part of the body, or with an artificial replacement.
Surgeons at Memorial Sloan-Kettering are able to save the limb in most bone cancer surgeries and have developed new replacements that are more durable and functional. Even if the entire limb cannot be preserved, surgeons will try to leave a limb that will function as well as possible with a prosthesis (artificial replacement). In some cases, doctors can even recreate functioning joints, such as knees, so that a leg will flex naturally even after the natural knee has been removed.
Memorial Sloan-Kettering doctors have participated in clinical trials that evaluated new limb replacement devices that may last longer than conventional prostheses. We led studies to create longer-lasting prostheses, such as the CompreSs implant -- a novel method to secure a knee replacement to the thigh bone. Since its approval by the Food and Drug Administration, we remain one of the few institutions equipped to perform such an operation. We are also using specially designed expandable prostheses in children that "grow" as a child grows.
Chemotherapy is often used prior to or following surgery, to either shrink the tumor before surgery or manage and control the tumor after surgery.
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Cryosurgery
Cryosurgery is sometimes used in addition to surgery in some patients with bone cancer. Memorial Sloan-Kettering surgeons were the first to use cryosurgery, and we have perfected its use to reduce tumor recurrence while preserving limb and joint function.
After a bone tumor is removed, liquid nitrogen is used to freeze the tumor cavity to subzero temperatures, killing microscopic tumor cells and decreasing the chance of tumor recurrence. The frozen bone is stabilized by filling the tumor cavity with bone graft, cement, or rods and screws to prevent fracture.
Adjuvant Approaches in Bone Cancer
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Suzanne Wolden Radiation Oncologist |
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Many patients will be free of all cancer following surgery. However, in some patients microscopic tumor cells that were not detectable before or during surgery will eventually grow. As a result, many patients now receive chemotherapy or chemotherapy and radiation therapy in addition to surgery. Such therapy -- known as adjuvant therapy -- increases the chances for a complete cure by destroying microscopic accumulations of cancer cells before they have an opportunity to grow larger. At Memorial Sloan-Kettering, we commonly deliver various forms of adjuvant therapy after surgery.
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Radiation Therapy
Radiation therapy is sometimes given together with surgery, to destroy tumors or to reduce the size of the tumor. Radiation therapy may also be used to kill remaining cancer cells after surgery, or treat tumors that cannot be surgically removed -- sometimes in combination with chemotherapy. In patients with cancer that has spread to the bones, radiation therapy may also be used to relieve symptoms, including pain.
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External-Beam Radiation Therapy
The most commonly used type of radiation therapy in bone cancer treatment is external-beam radiation, which uses doses of radiation delivered from outside the body, focusing on the region of the tumor and surrounding tissues. After postoperative recovery, a course of external beam radiation therapy is usually given. It can be given before or after surgery.
Research is also under way to evaluate the application of radiation directly to the bone during surgery (intraoperative radiation therapy).
Memorial Sloan-Kettering doctors are using a novel form of radiation therapy in some patients with sarcomas. Called intensity-modulated radiation therapy (IMRT), this technique targets tumors so precisely that it leaves surrounding healthy tissue unharmed.
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Brachytherapy
Brachytherapy, which involves delivering radiation therapy locally, can be administered in two different ways to treat bone cancer. In one approach, during surgery, after the surgeon removes the tumor, special tubes called catheters are inserted into the tumor bed. After allowing the surgical wound to heal for five to six days, the radiation oncologist inserts radioactive seeds into each of the catheters. The seeds stay in place for several days, delivering a high dose of radiotherapy to the site.
When the treatment is completed, both the radioactive seeds and the catheters are removed. A patient may finish the entire course of treatment within ten to 14 days. In certain situations, brachytherapy may be administered for two to three days combined with external radiation that is administered for five weeks.
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Chemotherapy
Chemotherapy is often used to treat primary bone cancers, in conjunction with surgery. Chemotherapy is commonly given after surgery to kill any cancer cells that remain in the body after the main tumor is removed surgically. Sometimes chemotherapy is given before surgery to reduce the size of the tumor before surgeons try to remove it. This type of treatment, called induction chemotherapy, was pioneered at Memorial Sloan-Kettering.
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Chemotherapy for Ewing's Sarcoma
Once a diagnosis of Ewing's sarcoma has been confirmed, patients will be treated with chemotherapy to shrink the tumor and to prevent new tumors from forming. Doctors will usually treat Ewing's sarcoma with chemotherapy involving a combination of drugs. The standard treatment includes vincristine, doxorubicin, and cyclophosphamide (VAdriaC), alternating with ifosfamide and etoposide. These drugs can cause damage to the bone marrow, so doctors may also need to treat the bone marrow damage caused by the chemotherapy.
New treatment agents with activity in Ewing's sarcoma are employed in the event the cancer recurs. Additional surgery and/or radiation therapy are also possible treatment approaches. We also offer a series of innovative, disease-specific clinical trials for this group of high-risk patients.
Myeloablative therapy with hematopoietic stem cell support is currently under study at Memorial Sloan-Kettering for certain high-risk patients with appropriately matched sibling donors. Myeloablative therapy is a very intense regimen of chemotherapy designed to destroy all cells that divide rapidly. These cells include some blood cells and hair cells, as well as cancer cells. Stem cells are self-renewing cells that create the various types of blood cells. Stem cell support involves enriching the stem cells and increasing the number of such cells after chemotherapy has been administered.
For information about clinical trials at Memorial Sloan-Kettering, please visit our clinical trial database.
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Chemotherapy for Osteosarcoma
If doctors decide that chemotherapy is needed after the osteosarcoma has been removed, they will usually use the drugs ifosfamide, cisplatin, methotrexate, and doxorubicin.
Treatment for patients with relapsed or metastatic disease is highly individualized. Treatment options include surgery, radiation therapy, and chemotherapy agents that may not have been used previously. Based on laboratory studies conducted here, we offer a series of innovative, disease-specific clinical trials for this group of high-risk patients.
Investigational Approaches
Find a Clinical Trial Find out about new research studies for bone cancer
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New approaches to treating bone cancer at Memorial Sloan-Kettering are constantly being developed to improve upon or enhance treatment options. Research protocols involving the study of investigational approaches are sometimes offered to eligible patients through the clinical trial process. Clinical trials are designed to advance the current standards of care.
For example, clinical trials are now underway to assess potentially more effective chemotherapy drugs for different kinds of bone cancer. One study will examine and evaluate the use of standard chemotherapy agents -- gemcitabine and docetaxel -- in patients with osteosarcoma, chondrosarcoma, and Ewing's sarcoma. Another study is examining the effects of a biological therapy called sorafenib (which is a type of tyrosine kinase, or protein enzyme) in patients with soft tissue and bone sarcoma.
Another study is assessing the use of trastuzumab (Herceptin®), a drug currently used to treat advanced breast cancer. Trastuzumab targets cancer cells that overproduce a protein called HER-2, which is found in excess in osteosarcoma tumors that recur following treatment.
For up-to-date details about current clinical trials at Memorial Sloan-Kettering, please visit our clinical trial database.
Last Updated: Feb. 8, 2006
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