Chemotherapy for Bone Cancer

Chemotherapy (chemo) is the use of drugs to treat cancer. Chemo is systemic treatment. This means that the drugs go into the bloodstream and circulate to reach and destroy cancer cells all over the body.

Chemo is often a part of treatment for Ewing sarcoma and osteosarcoma.

It isn’t used often for other bone cancers, like giant cell tumors, chordomas, and chondrosarcomas. These types aren’t very sensitive to chemo, so it doesn’t work well. It can be useful for a certain type of chondrosarcoma called mesenchymal and high-grade dedifferentiated chordomas. It may be used along with targeted therapy for some giant cell tumors.

Chemo is sometimes used for bone cancer that has spread through the bloodstream to the lungs and/or other organs.

Commonly used chemo drugs

The drugs mainly used to treat bone cancer include:

  • Doxorubicin (Adriamycin®)
  • Cisplatin
  • Etoposide (VP-16)
  • Ifosfamide (Ifex®)
  • Cyclophosphamide (Cytoxan®)
  • Methotrexate
  • Vincristine (Oncovin®)

In most cases, several drugs (2 or 3) are given together.

Side effects of chemotherapy

Chemo kills cancer cells, but it also damages some normal cells. You will be closely watched during treatment and your team will try to prevent or limit side effects. The side effects of chemo depend on the type of drugs, the doses used, and the length of time they're taken.

Some common short-term side effects include:

  • Nausea and vomiting
  • Loss of appetite
  • Hair loss
  • Mouth sores

It's important to tell your cancer care team about any side effects you have so they can be treated.

Chemotherapy can damage the blood-producing cells in the bone marrow, so you may have low blood cell counts. Low blood cell counts can result in:

  • Increased chance of infection (too few white blood cells)
  • Easy bleeding or bruising after minor cuts or injuries (too few platelets)
  • Fatigue or shortness of breath (too few red blood cells)

While you're getting chemo, your doctor will order lab tests to be sure your blood cell counts are at safe levels.

Some side effects are linked to certain drugs. For example:

  • Ifosfamide and cyclophosphamide can damage the lining of the bladder and cause bloody urine. This is called hemorrhagic cystitis. It can be prevented by giving a drug called mesna along with the chemo.
  • Cisplatin may cause nerve damage (called peripheral 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. Cisplatin can sometimes cause problems with hearing (known as ototoxicity). Most often patients with this problem notice they have trouble hearing high-pitched sounds. Your doctor may have you get a hearing test (called an audiogram) before giving cisplatin.
  • 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's safe to give you this drug.

It’s important to note that many of the serious side effects are rare, but they can happen. Talk with your cancer care team so you know what to expect from the chemo you're getting.

The doctors and nurses will watch closely for side effects. There are treatments for most side effects, but preventing them is important. Most side effects, if not all of them, will go away over time after treatment is over. Do not hesitate to ask your cancer care team any questions about side effects.

More information about chemotherapy

For more general information about how chemotherapy is used to treat cancer, see Chemotherapy.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Revised: February 5, 2018