Radiation Therapy for Bone Cancer

Radiation therapy uses high-energy rays or particles to kill cancer cells. It is a way to kill cancer cells that can't be removed with surgery. Radiation therapy doesn’t often play a major role in treating bone cancers, but it might be used in some situations.

Note: This information focuses on bone cancers that are seen most often in adults and start in the bones (primary bone cancers). Osteosarcoma, Ewing sarcoma, and bone metastases are covered separately.

When is radiation therapy used for bone cancer?

Bone cancer cells are not easily killed by radiation, so it doesn’t often play a major role in treating these cancers.

Radiation therapy might be used in some situations.

• After surgery: if it’s not clear that all the cancer was removed. For example, radiation may be used if cancer cells were found in the edges (margins) of the removed tissue. This is done to try to kill any cancer cells that might have been left behind.
• Instead of surgery: if the bone cancer can’t be removed (resected) completely. Radiation can slow tumor growth and control symptoms like pain and swelling. This might be done along with other treatments.
• If the cancer comes back: treat symptoms and slow regrowth of the cancer.

How is it given?

This type of treatment is given by a doctor called a radiation oncologist.

Treatment simulation: Before treatment starts, the radiation team creates a treatment plan. During a session called a treatment simulation, they use tests such as MRI scans to take careful measurements. Based on these tests and your cancer type, the team decides on the dose of radiation and where to aim it. The area where the radiation is given is known as the radiation field.

Mold or cast fitting: It is important that radiation is given to the exact field planned in the simulation. You may be fitted with a plastic mold that looks like a body cast to hold you in the same spot for each treatment.

During treatment: Radiation is usually given 5 days a week for several weeks. This type of treatment is like getting an x-ray, although the dose of radiation is much stronger. For each session, you lie down on a special table while a machine gives the radiation. The treatments are not painful. Each session lasts about 15 to 30 minutes. Most of this time is spent making sure the radiation is aimed correctly.

What type of radiation therapy is used for bone cancer?

Modern techniques help doctors aim radiation at tumors more accurately than they could in the past.

The best approach to radiation treatment may be different for everyone and depends on the type of bone tumor as well as the expertise and equipment available at your treatment center. Ask your cancer care team about the plan for you.

Intensity-modulated radiation therapy (IMRT)

IMRT is an advanced form of 3D radiation therapy. Along with shaping the beams and aiming them at the tumor from several angles, the intensity (strength) of the beams is adjusted to limit the dose reaching the most sensitive normal tissues. This lets doctors deliver a higher dose to the cancer areas. Many major hospitals and cancer centers now use IMRT.

Proton beam radiation therapy

Proton beam radiation uses radioactive particles that travel only a certain distance before releasing most of their energy.

This type of treatment can be helpful in treating tumors in small, intricate areas such as the base of the skull or the spine, where it's very important to limit the radiation that reaches nearby healthy tissues.

Carbon ion therapy

Like proton beam radiation, this method limits radiation exposure to healthy tissues and focuses radiation energy on the tumor. This method is only available in a few centers in the world.

Stereotactic radiosurgery (SRS)

This technique lets doctors give a large dose of radiation to a small tumor area, usually in one session.

Once imaging tests have been done to show the exact location of the tumor, a very thin beam of radiation is focused on the area from many different angles. This is typically done with a radiation source on the end of a computer-controlled robotic arm, which rotates around you as you lie on a table.

Sometimes doctors give radiation in several smaller treatments to deliver the same or dose or slightly higher. This is called stereotactic body radiotherapy (SBRT).

Side effects of radiation therapy

The side effects of radiation therapy depend on the dose of radiation and where the radiation is given. Short-term side effects of radiation happen during or shortly after treatment. Long-term side effects can take months or years to develop.

Short-term side effects

Side effects in the weeks during and after treatment may include:

• Fatigue
• Hair loss in the area receiving radiation
• Red, tender, or dry skin in the area receiving radiation, like a sunburn
• Low blood counts (this is more common when radiation is combined with chemo or other drugs)
• Mouth sores, trouble swallowing, or loss of appetite from radiation to the head and neck area
• Nausea, vomiting, cramps, and/or diarrhea from radiation to the abdomen or pelvis
• Damage to the bladder, which might cause pain or problems when passing urine (from radiation to the abdomen or pelvis)

Long-term side effects

Radiation affects how bones and tissues repair damage, grow, and work. Many late effects of radiation depend on where the radiation was given.

For example:

• If radiation is given to an arm or leg, scarring from radiation treatment can lead to movement limitations that may need treatment.
• Radiation to the neck or jaw may affect your jaw or teeth.
• Radiation to the pelvis may affect sex hormone production from the testes or ovaries.

It’s best to speak with your radiation team about the specific long-term side effects you may need to watch for.

Risk of a second cancer

Because radiation works by breaking DNA, it can also increase the risk of a second cancer many years later. Depending on where radiation was given, early cancer screening may be recommended.

Follow-up visits after radiation treatment 

To lower the risk of serious long-term effects from radiation, doctors try to use the lowest possible dose of radiation therapy. Still, it’s important to go to follow-up visits with your health care team so that if problems come up, they can be found and treated as soon as possible.