Treating Specific Types of Bone Cancer

The treatment of bone cancers in adults depends on the type of bone cancer, where the cancer started, its stage (extent), a person’s overall health and preferences, and other factors.

Often, more than one type of treatment is used. Treating these cancers can be complex, so they are often best treated by a team of different types of doctors who have experience with them.

The information here focuses on primary bone cancers (cancers that start in bones) that most often are seen in adults. Information on Osteosarcoma, Ewing Tumors (Ewing sarcomas), and Bone Metastasis is covered separately.

Chondrosarcoma

Treatment of chondrosarcomas is based mainly on: 

• The grade of the cancer (how likely it is to grow and spread quickly, based on how it looks under a microscope). Most chondrosarcomas are lower-grade tumors.
• The type of chondrosarcoma
• The location of the cancer
• Whether the cancer has spread outside the bone where it started

Once a biopsy of the tumor confirms the diagnosis, surgery to remove the tumor is typically the first treatment.

For low-grade chondrosarcomas confined to an arm or leg bone, curettage (intralesional excision) might be an option. The area where the tumor has been removed might then be treated with a chemical (such as phenol) or with extreme cold (cryotherapy) to try to kill any remaining cancer cells. The hole in the bone is then filled in with bone cement or with a bone graft. If curettage isn’t an option, a wide excision (either limb-sparing surgery or amputation) will be needed.

For low-grade chondrosarcomas in other bones and for all higher-grade chondrosarcomas, more extensive surgery will likely be needed. Limb-sparing surgery might be an option for tumors in the arm or leg bones, although sometimes amputation might be a better option to completely remove the cancer.

Chondrosarcomas in the skull can be hard to treat. They are often hard to remove completely with surgery, which might cause serious side effects. Some low-grade tumors can be treated with curettage.

For tumors that are harder to remove completely, radiation therapy might be given before and/or after surgery. Radiation can also be used if surgery can't be done for some reason. Chondrosarcoma cells aren’t killed easily by radiation, so high doses are needed. Techniques such as intensity-modulated radiation therapy (IMRT) or proton beam radiation are likely to work best for these tumors.

Chondrosarcomas that have spread to other parts of the body can be hard to treat.

• If there are only a few tumors, they may be removed surgically, along with the main tumor. Radiation therapy might be another option to treat tumors in other parts of the body.
• If there are many tumors, or if it’s clear that not all of them can be removed, treatment is more likely to be focused on relieving symptoms from the tumors and controlling their growth for as long as possible. Treatment options might include radiation therapy, surgery, or targeted drug treatments such as dasatinib or pazopanib.

Chemotherapy (chemo) is not usually very effective against chondrosarcoma cells, so it’s not often used to treat this type of cancer. Still, chemo can be used to treat some uncommon types of chondrosarcoma. For example:

• Dedifferentiated chondrosarcoma is often treated like osteosarcoma, with chemo being given first, followed by surgery and then more chemo.
• Mesenchymal chondrosarcomas are often treated the same way as Ewing tumors (Ewing sarcomas). Treatment typically includes chemo, surgery, and radiation therapy.

Because chondrosarcomas can often be hard to treat, taking part in a clinical trial testing newer treatments might be an option to consider.

Undifferentiated pleomorphic sarcoma (UPS) of bone

This cancer was previously known as malignant fibrous histiocytoma (MFH) of bone. It’s treated basically the same way as osteosarcoma is treated.

Chemotherapy usually is given first to shrink the tumor and to try to kill any cancer cells that might have spread. Then the tumor and some surrounding normal tissue is removed with surgery. The type of surgery will depend on the location of the tumor and other factors. Once the cancer has been removed, the bone may be reconstructed with a bone graft or with some type of man-made prosthesis. In some cases, chemotherapy is also given after surgery.

For more on how osteosarcoma (and therefore UPS) is treated, see Treating Osteosarcoma.

These tumors are not common and can be hard to treat, so taking part in a clinical trial testing newer treatments might be another option to consider.

Fibrosarcoma of bone

Surgery is usually the main treatment for this type of bone cancer. The goal is to remove the tumor and a margin of surrounding normal bone. The type of operation will depend on the location of the tumor and other factors.

These tumors tend to come back in the same place they started, so radiation therapy may be given after surgery to try to keep this from happening. Radiation might also be given if not all of the cancer can be removed, or if the doctor suspects that some cancer might have been left behind.

Radiation can also be used if a fibrosarcoma returns after surgery.

Chemotherapy might also be part of the treatment for these cancers, as they share some features with osteosarcomas and undifferentiated pleomorphic sarcomas. However, fibrosarcomas of bone are rare tumors, so using chemo against them hasn’t been studied thoroughly.

These tumors are not common and can be hard to treat, so taking part in a clinical trial testing newer treatments might be another option to consider.

Giant cell tumor of bone

These tumors do not usually spread to other parts of the body, but they are sometimes hard to remove completely.

Giant cell tumors are usually treated with surgery. Different types of operations can be used, depending on the size and location of the tumor.

Tumors that are only in the bone where they started can often be treated with curettage (intralesional excision). The area where the tumor has been removed might then be treated with a chemical (such as phenol) or with extreme cold (cryotherapy) to try to kill any remaining cancer cells. The hole in the bone is then filled in with bone cement or with a bone graft.

If curettage isn’t an option, a wide excision (either limb-sparing surgery or amputation) will likely be needed. Another option might be to try to shrink the tumor first to make it easier to remove. This can be done with drug treatment such as denosumab or interferon-alfa 2b, or with radiation therapy.

It’s not common for giant cell bone tumors to spread to other organs, but when they do, they usually go to the lungs first. If there are only a few tumors, it might be possible to remove them with surgery.

If surgery can’t be done to remove the tumor(s) completely, other options might include drug treatments (such as denosumab or interferon alfa-2b) or radiation therapy.

One concern with using radiation therapy to treat these tumors is that if the tumor is not destroyed completely, the radiation might increase the chance that it will come back as a more aggressive tumor.

Because these tumors tend to grow slowly, chemotherapy isn't likely to be helpful in treating them.

Chordoma

This rare type of bone tumor most often occurs in either the base of the skull or in the lower bones of the spine. It tends to grow slowly and doesn’t often spread to other parts of the body, but it can be hard to remove completely, and it often comes back in the place where it started.

Surgery is usually the main treatment for these tumors. The type of surgery depends on where the tumor is.

For tumors in the spine, a wide excision is usually done to remove the tumor along with some nearby normal tissue. It might not be possible to remove all of the tumor in some cases, such as if the spinal cord and nearby nerves are involved.

Tumors at the base of the skull are often hard to remove completely because they’re close to critical structures such as the brainstem and spinal cord. Curettage is often done to remove as much of the tumor as possible. This might be done through an incision in the skull, or through a small hole created in the back of the nose.

Radiation therapy might be given after surgery to lower the chance that the tumor will grow back. Doctors typically use techniques that allow them to control the radiation very precisely, such as proton beam radiation or intensity-modulated radiation therapy (IMRT).

Radiation therapy may also be used if the tumor can’t be removed with surgery for some reason.

Chordomas can come back, even many years after treatment, so long-term follow-up is important. If the tumor does come back, treatment options might include surgery and/or radiation therapy. Chemotherapy isn’t usually effective for chordomas, but newer targeted drugs such as imatinib, dasatinib, or sunitinib might be helpful in treating these tumors.