Chemotherapy 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 might 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 called neo adjuvant chemotherapy. 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 lower the risk of the cancer coming back. This is known as adjuvant chemotherapy.
Some people 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.
This is called chemoradiotherapy. 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.
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 be able to have a different treatment if the first treatment isn’t working or the side effects are too bad. This is called second line treatment. Your doctor will discuss with you what options are available to you in this situation.
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
- new treatments and different combinations of treatments
- comparing treatments to improve survival
- how treatment affects
quality of life 
Types of chemotherapy for bone cancer
There are many different chemotherapy drugs to treat bone cancer. You usually have a combination of drugs.
Some of the common chemotherapy drugs for bone cancer are:
The most common chemotherapy regime used to treat Ewing sarcoma is:
- VDC/IE (vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide)
High dose chemotherapy with stem cells
Very rarely 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 called MAP.
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 sarcoma comes back after treatment you are likely to have treatment with:
- ifosfamide
- etoposide
- irinotecan and temozolamide
- cyclophosphamide and topotecan
- carboplatin and etoposide
We have specific information about each of these drugs on our cancer drugs A to Z list.
How you have chemotherapy
You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
Or you might have it through a long plastic tube that goes into a large vein in your chest. This might be a:
- central line
- PICC line
- Portacath
The tube stays in place throughout the course of treatment.
You might have some drugs as tablets.
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 things in to do. For example, newspapers, books or electronic devices can all 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.
Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.
Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.
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, such as 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.
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test.
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 replaces your . 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:
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feeling sick
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loss of appetite
-
losing weight
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feeling very tired
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increased risk of getting an infection
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bleeding and bruising easily
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diarrhoea or constipation
-
hair loss
Contact your hospital advice line immediately if you have signs of infection. These include a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.
Side effects depend on:
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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
- have been prescribed anything by alternative or complementary therapy practitioners
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.
