Radiation Therapy for Bone Cancer

Radiation therapy uses high-energy rays or particles to kill cancer cells. External beam radiation therapy is radiation delivered from outside the body that's focused on the cancer. This is the type of radiation therapy used to treat bone cancer.

Most bone cancers are not easily killed by radiation, and high doses are needed. High doses, however, can damage nearby healthy tissues, as well as key structures (like nerves and blood vessels) in the area. This is why radiation therapy is not used as a main treatment for most types of bone tumors. (It is often used for Ewing tumors.)

Most of the time, radiation is used to treat bone cancers that are unresectable. This means they cannot be completely removed with surgery.

Radiation may also be used after surgery if cancer cells were found in the edges (margin) of the removed tissue. Another term for this is positive margins. (This is discussed in the section about surgery.) In this case, radiation may be given to kill any cancer that may have been left behind.

If bone cancer comes back after treatment, radiation can help control symptoms like pain and swelling.

Types of radiation therapy

Special types of radiation are most commonly used to treat bone cancer. These types give doctors the best control over the size and strength of the radiation beams so that higher doses get to the tumor and spare the nearby tissues.

Intensity-modulated radiation therapy

Intensity-modulated radiation therapy (IMRT) is an advanced form of external beam radiation therapy. With this technique, a computer matches the radiation beams to the shape of the tumor and can adjust the intensity (strength) of the beams. The radiation is delivered to the tumor from many directions to reduce the amount of radiation that goes through any one area of normal tissue. This makes it possible to reduce radiation damage to normal tissues while increasing the radiation dose to the cancer.

Proton-beam radiation

Proton-beam radiation is a special form of radiation that uses protons instead of regular x-rays to kill cancer cells. Protons are positively charged particles that are found inside all atoms. They cause little damage to the tissues they pass through but are very good at killing cells at the end of their path. This allows a high dose of radiation to be given to the tumor without hurting the normal tissue around it. Proton-beam radiation therapy requires highly specialized equipment and is not available at all medical centers. This form of radiation is very helpful in treating skull, spine, rib, or sternum (breast bone) chondrosarcomas and chordomas.

Extracorporeal radiation

Though not commonly used, another option is extracorporeal radiation. This may be used when trying to save a limb as part of limb-salvage surgery. It involves taking the bone with cancer out of the body, treating it with radiation, and then putting it back in.

Side effects linked to this include wound healing problems, loss of joint movement, change in limb length, and fractures (breaks) in the treated piece of bone.

Side effects

Side effects of radiation therapy depend on what area of the body is being treated and how much radiation is used. Common side effects include:

  • Fatigue (tiredness)
  • Loss of appetite
  • Skin changes in the area being treated, ranging from redness and hair loss to blistering and peeling
  • Low blood counts
  • Nausea, vomiting, and diarrhea (these are more common if radiation is given to the belly)

You can learn more in the radiation section of our website. 

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Chauhan S, Manoj K, Rastogi S, Khan SA, Prasad A. Biomechanical investigation of the effect of extracorporeal irradiation on resected human bone. J Mech Behav Biomed Mater. 2017;65:791-800.

Gutowski CJ, Basu-Mallick A, Abraham JA. Management of Bone Sarcoma. Surg Clin N Am. 2016;2016:1077–1106.

Hong AM, Millington S, Ahern V, et al. Limb preservation surgery with extracorporeal irradiation in the management of malignant bone tumor: the oncological outcomes of 101 patients. Ann Oncol. 2013;24(10):2676-2680.

National Cancer Institute. Bone Cancer. March 13, 2008. Accessed at www.cancer.gov/types/bone/bone-fact-sheet on December 5, 2017.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Bone Cancer. Version 1.2018 -- August 29, 2017.

Van Gompel JJ, Janus JR. Chordoma and Chondrosarcoma. Otolaryngol Clin N Am. 2015;48:501–514.

Last Medical Review: November 28, 2017 Last Revised: February 5, 2018