For specific information on treating Ewing sarcoma and osteosarcoma, please the American Cancer Society documents on those cancers.

Chondrosarcoma

After a biopsy confirms the diagnosis, treatment consists of surgery 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, the metastases may be removed surgically if there are only a few.

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 has been found to work well for these tumors.

Chemotherapy is not often used to treat chondrosarcoma, but it is used to treat some of the variants of this cancer. For example, dedifferentiated chondrosarcoma may be treated like osteosarcoma, with chemotherapy followed by surgery and then more chemotherapy. Patients with mesenchymal chondrosarcomas also receive chemotherapy prior to surgery. These tumors are given the same treatment as Ewing tumors.

Malignant fibrous histiocytoma (MFH)

MFH is treated the same way osteosarcoma is treated. (Please see the American Cancer Society document, Osteosarcoma for more detailed information.) Often the patient is first treated with chemotherapy to shrink the tumor. Then a wide-resection is done to remove the tumor (see the previous section about treatment for more details). 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.

Fibrosarcoma

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 tumor of bone

These are treated mainly with surgery. Different surgeries are used, depending on the size and location of the tumor. One option is to remove the part of the bone affected by the tumor, 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.

One option to wide-excision 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 can also be treated by with radiation.

Chordoma

This primary tumor of bone most often occurs in the base of the skull or the bones of the spine. Removing the tumor completely with surgery is not always possible because the spinal cord and nerves nearby may be involved. Radiation is often given after surgery to lower the chance that the tumor will grow back. Proton-beam radiation, either alone or along with intensity-modulated radiation therapy, is often used. Chemotherapy may be tried for a chordoma that has spread widely, but so far it hasn't worked well. Chordomas can come back, even 10 or more years after treatment, so long-term follow-up is important.

Last Medical Review: 07/14/2009
Last Revised: 07/14/2009