Chemotherapy (anti-cancer medication) is an important treatment for bone tumours. It can be used to help shrink the tumour before surgery or radiotherapy and is also given after surgery or radiotherapy.
what happens?
Chemo for bone tumours is given by injection into a vein (intravenously). This is usually through a central line, an implantable port or a PICC line.
Each cycle of chemo usually lasts a few days. This is followed by a rest period of a few weeks so that your body can recover from any side effects. You'll probably need to stay in hospital for some of that time but it is often possible to have part of your treatment as an outpatient.
If you want more info about how it's given and the drugs used, see our chemo section.
The type of chemo you have depends on whether the tumour is a Ewing’s sarcoma or an osteosarcoma.
Ewing’s sarcoma
Ewing’s sarcoma can occur in the bone or the soft tissue. If you have a soft tissue Ewing’s sarcoma it’s treated like a Ewing’s sarcoma in the bone. The chemo for Ewing’s sarcoma is usually given in two parts:
First, you would have 6 lots (cycles) of a combination of 4 chemo drugs. This chemo is called VIDE: Vincristine, Ifosfamide, Doxorubicin and Etoposide. You’ll often have surgery after finishing the course of VIDE and then more chemo. After the 3rd cycle of VIDE, you'll have stem cells collected (harvested). Stem cells are very early blood cells, which are collected and stored in case you need them later for a stem cell transplant.
Next, you would usually have 1 cycle of VAI (Vincristine, Actinomycin D and Ifosfamide) chemo followed by a further 7 cycles of VAI or VAC (Vincristine, Actinomycin D and Cyclophosphamide) chemo. This is to make sure all of the tumour has been destroyed, to stop it coming back or spreading to other parts of the body.
Usually, when all of the tumour is destroyed after chemo it's pretty unlikely that it will come back. But, if some of the tumour remains, it may cause problems either in the original area or by spreading to another part of the body. Doctors who specialise in bone tumours are trying to find out the best way to stop this happening. The best way to do this is through clinical trials. At the moment most people having treatment for Ewing’s sarcoma will be part of a trial called the Euro-Ewing 99 trial. This trial aims to compare different combinations of treatment to decide which one works best.
If you’re not taking part in a trial your doctor will decide what treatment you have. If you're taking part in the Euro-Ewing 99 trial, a computer will allocate you to a treatment group. You’ll be given lots of information at the hospital about what the trial involves and you can ask as many questions as you like - to help you understand what’s involved.
osteosarcoma
The usual treatment plan is a combination of 3 chemo drugs and is referred to as MAP: Methotrexate, doxorubicin (Adriamycin), cisPlatin.
You'll receive 6 cycles of chemo, each given over about 5 weeks - with surgery to remove your primary tumour after the first 2 cycles.
what about side effects...
Different chemo drugs cause different side effects. Some people just have a few side effects and others have more. It's hard to predict how it’s going to be for you as everyone is different and reactions can vary from treatment to treatment.
Almost all side effects are short term and will gradually disappear once treatment stops. The most common side effects are hair loss, tiredness, sickness (which can be controlled) and a lowered immune system which means you pick up infections more. Your mouth may become sore and you may get pins and needles in your fingers and toes because of the effects of the chemo on the nerves. You may also feel low in mood.
If you want to know more about the regimes and side effects of chemotherapy, there is lots more information in the chemotherapy section and the deal with it section.
