Treating Specific Bone Cancers

Information on treating Ewing sarcoma and osteosarcoma is not covered here. Please see the American Cancer Society information on those cancers to learn more.

Chondrosarcomas

After a biopsy confirms the diagnosis, surgery is done to remove the tumor. Again, it's 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 lungs and there are only a few tumors, they may be removed surgically.

Chondrosarcomas in the skull are hard to treat. Complete surgical removal is difficult, and might cause serious side effects. Some low-grade tumors are treated with curettage and cryosurgery.

Sometimes the patient is treated with radiation therapy before and/or after surgery. Radiation can also be used if surgery can't be done. Since chondrosarcomas are resistant to radiation, high doses are required. Proton-beam radiation works best for these tumors.

Chemotherapy (chemo) is not often used to treat chondrosarcoma, because it doesn't work. Most types of chondrosarcoma are resistant to chemo. Still, chemo can be used to treat some special types of chondrosarcoma. For example, dedifferentiated chondrosarcoma is often treated like osteosarcoma, with chemo followed by surgery and then more chemo. Patients with mesenchymal chondrosarcomas also get chemo before surgery. These tumors are treated the same as Ewing tumors or soft tissue sarcomas.

Malignant fibrous histiocytomas (MFH)

MFH is treated the same way osteosarcoma is treated.

Often the patient is treated first with chemotherapy to shrink the tumor. Then the tumor and some surrounding normal tissue is removed (wide-excision). After surgery, 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.

Fibrosarcomas

Surgery is the main treatment for this kind of cancer. The goal is take out the tumor and a margin of surrounding normal bone.

This tumor tends to come back in the same place it started, so radiation may be given after surgery to help keep this from happening. Radiation is also used if the doctor suspects that some cancer has been left behind.

Radiation is sometimes used instead of surgery if the tumor cannot be removed completely. It also can be used if a fibrosarcoma returns after surgery.

Chemotherapy may be tried, but this has not been studied well, and it's not clear that it helps.

Giant cell tumors of bone

These are treated mainly with surgery. Different operations are used, depending on the size and location of the tumor. Overall, treatment is much like the treatment for osteosarcoma.

One option is wide-excision. This often means removing the part of the bone that has the tumor, and replacing it with a bone graft or prosthesis (such as a metal rod). If this operation can be done without seriously affecting the ability of the limb to move or without causing serious damage to nearby tissues, this approach has a good likelihood of success.

Another option is curettage followed by cryosurgery. The defect (hole) in the bone can then be filled in with bone cement or a bone graft.

Amputation is rarely needed to treat a giant cell tumor.

Radiation therapy may sometimes be used for giant cell tumors in bones where surgery may be hard to do without damaging nearby sensitive tissues − such as tumors in the skull or spine. Radiation is not often used to treat giant cell tumors because if the non-cancerous tumor is not completely destroyed, it might increase the chance that it comes back as cancer.

If a giant cell bone tumor spreads to other organs, the lungs are most commonly affected. If there are only a few tumors in the lungs, it might be possible to remove them surgically.

Because these tumors are benign, chemotherapy isn't used.

Both primary tumors and metastases that can’t be removed can be treated with radiation with or without the targeted therapy drug denosumab (Xgeva).

Chordomas

This rare primary tumor of bone most often occurs in the base of the skull or the lower bones of the spine. The best treatment is a wide excision to remove all of the tumor with some nearby normal tissue. This is not always possible because the spinal cord and nearby nerves may be involved. Still, as much of the tumor will be removed as possible .

Radiation may be given after surgery to lower the chance that the tumor will grow back. Proton-beam radiation, either alone or with intensity-modulated radiation therapy, is best. Radiation may also be used if the tumor cannot be taken out with surgery.

Imatinib (Gleevec) is a targeted therapy drug that may be used for a chordoma that has spread widely. It rarely shrinks the tumors, but it can slow down tumor growth and help ease symptoms.

So far, chemo hasn’t been found to work by itself. Still, it may be used to treat high-grade/dedifferentiated types of chordoma.

Chordomas can come back, even 10 or more years after treatment, so long-term follow-up is important.

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.

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