Treating Specific Bone Cancers
After a biopsy confirms the diagnosis, surgery is done to remove the tumor. Again, it is important that the biopsy be done by the same surgeon who will remove the tumor. For a low-grade chondrosarcoma in an arm or leg, curettage with cryotherapy is an option. If the tumor is high-grade, limb-sparing surgery will be done if possible. Sometimes amputation is needed to completely remove the cancer. If the chondrosarcoma has spread to the lung and there are only a few metastases, they may be removed surgically.
Chondrosarcomas in the skull are hard to treat. Complete surgical removal is difficult, and may cause serious side effects. Some low-grade tumors are treated with curettage and cryosurgery.
Sometimes the patient is treated with radiation therapy. Since chondrosarcomas are resistant to radiation, high doses are required. Proton-beam radiation works well for these tumors.
Chemotherapy (chemo) is not often used to treat chondrosarcoma, because most types of chondrosarcoma are resistant to chemo. Chemo can be used to treat some special types of chondrosarcoma. For example, dedifferentiated chondrosarcoma may be treated like osteosarcoma, with chemo followed by surgery and then more chemo. Patients with mesenchymal chondrosarcomas also get chemo before surgery. These tumors are treated the same as Ewing tumors or soft tissue sarcomas.
Malignant fibrous histiocytomas (MFH)
MFH is treated the same way osteosarcoma is treated. (See Osteosarcoma for more detailed information.) Often the patient is first treated with chemotherapy to shrink the tumor. Then the tumor and some surrounding normal tissue is removed (wide-excision). After resection, the bone may be reconstructed with a bone graft or a prosthesis (metallic rod). Amputation is rarely needed. In some cases, chemotherapy is also given after surgery.
Surgery is the main treatment for this kind of cancer, with the goal of removing the tumor and a margin of surrounding normal bone. Radiation is sometimes given after surgery if the doctor suspects that some cancer has been left behind. Radiation therapy is sometimes used instead of surgery if the tumor cannot be removed completely. Radiation is also used if a fibrosarcoma returns after surgery.
Giant cell tumors of bone
These are treated mainly with surgery. Different surgeries are used, depending on the size and location of the tumor. One option is wide-excision. This often means removing the part of the bone containing the tumor, and replacing it with a bone graft or prosthesis (such as a metal rod). If this operation can be done without seriously affecting the movement of the limb or without causing serious damage to nearby tissues, this approach provides a good likelihood of success.
Another option is curettage followed by cryosurgery. The defect (hole) in the bone can then be filled in with bone cement or a bone graft.
Radiation therapy may sometimes be used for giant cell tumors in bones where surgery may be difficult to perform without damaging nearby sensitive tissues − such as the skull and the spine. Radiation is not often used to treat giant cell tumors because if the tumor is not killed completely it may increase the chance that it comes back in the malignant form.
Amputation is rarely needed to treat a giant cell tumor.
If a giant cell bone tumor spreads to other organs, the lungs are most commonly affected. If there are only a few metastatic tumors in the lungs, it may be possible to remove them surgically. Metastases that can’t be removed can be treated with radiation or with the drug denosumab (Xgeva).
This primary tumor of bone most often occurs in the base of the skull or the bones of the spine. The best treatment is a wide excision to remove the tumor completely with some nearby normal tissue. This is not always possible because the spinal cord and nerves nearby may be involved. Still, as much of the tumor as possible will be removed.
Radiation is often given after surgery to lower the chance that the tumor will grow back. Proton-beam radiation, either alone or with intensity-modulated radiation therapy, is often used.
Imatinib (Gleevec) is often used for a chordoma that has spread widely. It may rarely shrink the tumors, but often can stop them from growing for a while. Studies are looking at adding other drugs to imatinib when it stops working (this is discussed in the section, “ What’s new in bone cancer research and treatment?”). Chemo may be tried as well, but so far it hasn’t worked well by itself. Chordomas can come back, even 10 or more years after treatment, so long-term follow-up is important.
Last Medical Review: March 21, 2014 Last Revised: January 21, 2016