Chemotherapy for bone cancer
Chemotherapy (chemo) is the use of drugs to treat cancer. Chemo is systemic therapy. This means that the drug enters the bloodstream and circulates to reach and destroy cancer cells throughout the body.
Chemo is often a part of treatment for Ewing sarcoma and osteosarcoma, but it isn’t often used for other bone cancers, like chordomas and chondrosarcomas, because they aren’t very sensitive to chemo and so it often doesn’t work well. It can be useful for some special types of chondrosarcoma, like dedifferentiated and mesenchymal.
Chemo is sometimes used for bone cancer that has spread through the bloodstream to the lungs and/or other organs. The drugs mainly used to treat bone cancer include:
- Doxorubicin (Adriamycin®)
- Etoposide (VP-16)
- Ifosfamide (Ifex®)
- Cyclophosphamide (Cytoxan®)
- Vincristine (Oncovin®)
Usually, several drugs (2 or 3) are given together. For example, a very common combination is cisplatin and doxorubicin. Other combinations are ifosfamide and etoposide or ifosfamide and doxorubicin
Side effects of chemotherapy
Chemo kills cancer cells, but it will also damage some normal cells. Careful attention is given to avoid or minimize side effects. The side effects of chemo depend on the type of drugs, the amount taken, and the length of time they are taken.
Some common temporary side effects can include:
- Nausea and vomiting
- Loss of appetite
- Hair loss
- Mouth sores
It is important to tell your cancer care team about any side effects you have so that they can be prevented or controlled.
Chemotherapy can damage the blood-producing cells of the bone marrow and lymph nodes, so patients may have low blood cell counts. Low blood cell counts can result in:
- Increased chance of infection (too few white blood cells)
- Bleeding or bruising after minor cuts or injuries (too few platelets)
- Fatigue or shortness of breath (too few red blood cells)
Some side effects are specific to particular drugs. It’s important to note that many of the serious side effects are rare, but possible. Discuss these with your cancer care team if you have concerns before treatment.
Ifosfamide and cyclophosphamide can damage the lining of the bladder and cause bloody urine. This is called hemorrhagic cystitis. This problem can be prevented by giving a drug called mesna along with the chemo.
Cisplatin may cause nerve damage (called neuropathy) leading to problems with numbness, tingling, and even pain in the hands and feet. Kidney damage (called nephropathy) can also occur after treatment with cisplatin. Giving lots of fluid before and after the drug is infused can help prevent this side effect. Cisplatin can sometimes cause problems with hearing (known as ototoxicity). Most often patients with this problem notice problems hearing high-pitched sounds.
Over time, doxorubicin can damage the heart. The risk of this goes up as the total amount of the drug given goes up. Before giving doxorubicin, your doctor may test your heart function to make sure that it is safe to give you this drug.
The doctors and nurses will watch closely for side effects. There are treatments for most side effects, but preventing significant side effects is more important. Most, if not all, of these side effects will eventually stop after the treatment is over. Do not hesitate to ask your cancer care team any questions about side effects.
While you are being treated, your doctor will order lab tests to be sure your liver, kidney, and bone marrow (which produces the cells in the blood) are functioning well.
- The complete blood count (CBC) includes levels of white blood cells, red blood cells, and platelets.
- Chemistry panels measure certain blood chemicals that tell doctors how well the liver and the kidneys are working. Some drugs used in chemotherapy can damage the kidneys and liver.
If a drug can damage hearing, the doctor may order a hearing test (called an audiogram) before giving it.
For more information about chemotherapy in general, see our document A Guide to Chemotherapy.
Last Medical Review: 03/21/2014
Last Revised: 01/21/2016