How is bone cancer treated?

Surgery to remove the cancer is a primary resort for bone cancers. Surgical techniques can eliminate the cancer without the need for amputation of the limb involved. Limb-sparing surgery avoids amputation. But when affected muscles and other tissues that surround the region need to be removed, reconstructive surgery may be required along with cancer resection to bring back the limb to optimum functioning.

Cancer types like Ewing Sarcoma and osteosarcoma may require both surgery and chemotherapy. Chondrosarcoma is typically treated with radiation therapy. Read more on chemotherapy here.

Chemotherapy in the treatment of Bone Cancer

It is often used in the treatment of Osteosarcoma and Ewing Sarcoma.  And it is not effective for other types of bone cancers because they are not sensitive to the drugs that are prescribed. Read more on chemotherapy

Chemotherapy uses the technique of using anti-cytotoxic drugs to kill cancer cells. A few of its primary functions are to starve cancer cells, impede their cell division and triggering their suicide. While side effects remain, there is attempt to research on drugs that will minimize adverse effects, which are, nausea, weakness, fatigue, bowel related issues, and blood related issues etc.

Common drugs for osteosarcoma include:

  • Cisplatin (Platinol)
  • Doxorubicin (Adriamycin)
  • Ifosfamide (Ifex)
  • Methotrexate (multiple brand names)

Common drugs for Ewing sarcoma include:

  • Vincristine (Oncovin, Vincasar)
  • Doxorubicin (Adriamycin)
  • Cyclophosphamide (Cytoxan, Neosar)
  • Ifosfamide (Ifex)
  • Etoposide (Toposar, VePesid)
  • Dactinomycin (Cosmegen)

Radiation

Radiotherapy is given to those patients who tumors are unresectable which means that they cannot be treated with surgery.

Types of Radiation Therapy

Special types of radiation therapy are most commonly used to treat bone cancer.

1. Intensity-modulated therapy is a sophisticated technique of radiation therapy in which a computer matches radiation beams to the size and the severity of the tumor. The radiation is directed at the tumor from different angles.

2. Proton beam radiation uses beams of positively charged particles of atoms instead of
regular X-rays. This is most popular in treating skull, spine, rib, or sternum
chondrosarcomas and chordomas.

3. Extracorporeal is used as part of limb-salvaging surgery which involves taking the
infected bone out of the body, treating it with cancer and putting it back. Side-effects like fatigue, nausea, loss of appetite, low blood counts prevail after the radiotherapy.

Surgery

Surgery is another important part of treatment. The aim is to remove cancer cells completely. Different types of surgery need to be conducted for different types and grades of cancer, depending on its size and severity; namely, limb-salvaging surgery, amputation surgery, reconstructive surgery and surgery for metastasis.
Side effects include infection around the wound, hemorrhage, urinary issues, shortness of breath, rehabilitation from physical and emotional distress etc.
Read more about surgery for bone cancer {Insert surgery in the treatment of bone cancer article hyperlink here} and its complications {Insert complications of surgery article hyperlink here} here.

Stem-cell transplants

When Ewing sarcomas are not particularly sensitive to chemotherapy, it may require radiation therapy and perhaps even stem-cell transplants. Stem cell transplants kill bone marrow cells of the affected region and new cells are induced through the veins to replace destroyed cells through a blood transfusion. Eventually, these new cells adapt to settling down to make healthy bone cells. This process is known as engrafting.

There are two types of stem-cell transplants:

1) Autologous stem-cell transplants

Autologous transplant is primarily used to treat certain leukemias, lymphomas, and multiple myeloma. There are no risks of new cells attacking the body (known as the graft-versus-host cancer effect)

2) Allogeneic stem-cell transplants

In allogeneic stem-cell transplants, there may be two kinds of donors. One, a close family member and two, a donor from the general public called the MUD or matched unrelated donor. MUD type of transplants is usually riskier than those from a relative of the patient’s.

Targeted therapies

Targeted uses drugs to treat cancers but is different from the customary chemotherapy. It works by targeting specific proteins and genes to impede the growth and spread of cancer. The U.S. Food and Drug Administration (FDA) has authorized targeted therapies for many types of cancer. The primary aims of using these drugs are:

  1. To disable the growth and division of cancer cells
  2. To prevent cells from living longer than usual
  3. To destroy cancer cells

Examples

Denosumab (Xgeva) is a monoclonal antibody that acts to block the activity of osteoclasts. Used in the treatment of giant cell tumors of bone that has relapsed after surgery or that cannot be removed, it has proved effective.

Clinical trials

Clinical trials are research studies that doctors use to find new ways to improve medical technique and technology. It is important that health professionals talk to the patient and the patient’s family about the nature, extent, and safety of the trial. Clinical trials are used for the following reasons:

  1. To find and diagnose cancer
  2. To treat cancer
  3. To prevent cancer
  4. To cope with symptoms of cancer and handle its side effects

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