Radiotherapy for bone cancer

About radiotherapy for bone cancer

Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells.

Radiotherapy is mainly used to treat Ewing sarcoma, often with surgery. It can be given either before or after surgery.

It may also be given with chemotherapy for some Ewing sarcoma. This is called chemoradiation.

If it is not possible to have surgery to remove the Ewing sarcoma, radiotherapy may be used as the main treatment.

Other types of primary bone cancer are less sensitive to radiation. But if surgery is not possible, radiotherapy may sometimes be used instead.

How radiotherapy is given

Bone cancer is treated with external beam radiotherapy. Depending on where the bone cancer is, different techniques may be used:

Intensity-modulated radiation therapy (IMRT)

This type of radiotherapy is often used to treat primary bone cancer. IMRT shapes the radiotherapy beams to give the cancer a high dose of radiation. It may also allow different doses of radiotherapy to be given to different areas. This means lower doses are given to nearby healthy tissue. This can help reduce side effects and possible late effects.
Volumetric-modulated arc radiotherapy (VMAT)

VMAT is a newer way of giving IMRT that might be used for some bone cancers. The radiotherapy machine moves around you and reshapes the beam during treatment. This makes it more accurate and shortens the treatment time.
Proton beam therapy

Proton beam therapy uses proton radiation to destroy cancer cells, instead of x-rays. Proton beams can be made to stop when they reach the area being treated. This is different to standard radiotherapy beams, which pass through the area and some healthy tissue around it. This means it causes very little damage to nearby healthy tissue and fewer side effects. It may be used to treat cancer in the spine or bottom of the skull.

Before you start radiotherapy, the radiotherapy team will plan your treatment. This makes sure the radiotherapy is aimed directly at the cancer, causing the least possible damage to nearby healthy tissue. The planning may take a few visits.

Planning scans

As part of the planning, you will have a CT scan of the area to be treated. This helps plan the precise area for your radiotherapy. This session takes about 30 minutes.

You may also need to have an MRI scan. This uses magnetism to build up a detailed picture of part of your body.

The information from the scans is put into the radiotherapy planning computer. The computer designs your individual treatment plan.

Radiotherapy moulds

Radiotherapy moulds may be used to help keep the part of the body having radiotherapy still during treatment. If you are having radiotherapy to your head and neck, you will have a head and neck mould made. If you are having radiotherapy to a limb or chest, you may also need a mould for these areas.

You will not need a mould if you are having radiotherapy to your tummy area or pelvis. You will be supported with pillows that are shaped to fit around the area of the body having radiotherapy. These help keep you comfortable and still during treatment, so each radiotherapy treatment is delivered accurately. Other devices, including foam blocks, or special cushioning bags called vacuum bags, may be used to help keep you still during treatment.
Skin markings

To help the radiographers position you correctly for the treatment, they may make marks on your mould. If you do not have a mould, they will draw the marks on your skin. These marks must stay throughout your treatment. They can be washed off after your course of treatment finishes.

Often, very small, permanent markings are made on the skin. They will only be made with your permission. It can be uncomfortable while the marks are being made, but only for a very short time.
Radiotherapy to the pelvis

If you are having radiotherapy to the pelvis, you may need a small operation first. This is so that the surgeon can put a spacer inside the tummy (abdomen). This helps move the organs out of the way of radiotherapy and protect them from damage. Your cancer doctor will tell you more about this operation if it is needed.

Having radiotherapy for bone cancer

Radiotherapy is normally given as a series of short, daily treatments in the hospital radiotherapy department.

The treatments are usually given every day from Monday to Friday. The number of treatments you have depends on the type, size and position of the area to be treated.

A course of treatment for early-stage primary bone cancer lasts about 6 weeks. Each treatment takes about 10 to 15 minutes. Your cancer doctor will talk to you about the treatment and possible short or longer-term side effects.

At the start of each session of radiotherapy, the radiographer will explain what to expect. They will position you carefully on the treatment couch in the same way as during the planning session. When you are in the right position, the radiographers will leave the room and you will be given your treatment. Radiotherapy is not painful, but you will have to lie still for a few minutes during the treatment.

The radiographers will be able to see and hear you during your treatment.

Side effects of radiotherapy for bone cancer

You may develop side effects during your treatment. Side effects will depend on where in the body the radiotherapy is given. These side effects will slowly disappear over a few weeks or months after treatment finishes.

Your cancer doctor, specialist nurse or radiographer will explain the ones you are most likely to get, so you know what to expect. Let them know about any side effects that you have during or after treatment. There are often things that can be done to help. They will also explain about any possible late effects of the treatment.

Tiredness (fatigue)

Tiredness is a common side effect and may continue for months after treatment finishes. Try to get plenty of rest but balance this with some gentle exercise, such as walking. This can improve your energy levels and help you feel better.

After your treatment finishes, you can gradually increase your activity.

Feeling sick (nausea)

If the treatment area is near the tummy and pelvis you may feel sick and sometimes be sick (vomit). Your doctor can prescribe anti-sickness drugs (anti-emetics) to control this. Take them as your doctor has prescribed and let them know if a drug is not working. They can prescribe a different anti-sickness drug.

If you lose your appetite, let your GP know. They can prescribe some high-calorie drinks. They can also refer you to a dietitian who can explain how you can build up your diet.

Skin reaction

You may find your skin in the treatment area:

becomes red
darkens
feels sore
feels itchy.

Sometimes the skin gets very sore. It may blister, break or leak fluid. Very rarely, treatment may be stopped for a short time to allow skin to recover from a serious reaction.

Skin reactions can take time to improve. They are usually better by about 4 weeks after treatment finishes. In the longer term, the area of skin may look or feel slightly different to the surrounding skin.

Your radiographers or nurses will give you advice on how to look after your skin during and after treatment.

Hair loss

Radiotherapy can make your hair fall out in the area being treated. It may grow back after treatment finishes, but for some people the hair loss is permanent. This depends on how much radiotherapy you have. Your cancer doctor or radiographer can tell you if your hair is likely to grow back after treatment.

Long-term side effects of radiotherapy

Some people may have long-term or late effects of radiotherapy. These can develop months or sometimes years after treatment. If you have any new symptoms or problems after treatment, always let your cancer doctor or specialist nurse know.

Stiffness

If you have radiotherapy to a limb or a joint, it can become stiff. If you notice this, talk to your cancer doctor. They can prescribe painkillers to help. It is important to keep the joint mobile by using it and doing regular exercise. A physiotherapist will give you some exercises to do before, during and after treatment to help prevent stiffness.

Lymphoedema

After radiotherapy, some people may develop swelling called lymphoedema. It happens because the lymph nodes and vessels can be damaged by radiotherapy or surgery. Lymph fluid, which circulates around the lymphatic system, cannot pass along the vessels. It builds up, causing swelling.

Let your doctor know about any swelling you have after radiotherapy treatment. They can explain how it can be managed. There are things you can do to help reduce the risk of lymphoedema.

Support from Macmillan

Macmillan is here to support you. If you would like to talk, you can do the following:

Call the Macmillan Support Line free on 0808 808 00 00.
Chat to our specialists online.
Visit our radiotherapy and side effects forum to talk with people who have been affected by radiotherapy, share your experience, and ask an expert your questions.

Booklets and resources

We have information on radiotherapy in other formats:

Find out more about our information in other languages and formats.

About our information

References

Below is a sample of the sources used in our information about primary bone cancer. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

European Society for Medical Oncology, ESMO. 2021. Bone sarcomas: ESMOeEURACANeGENTURISeERN PaedCan Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology. S. J. Strauss1 et al. Available at: https://www.esmo.org/guidelines/guidelines-by-topic/sarcoma-and-gist/bone-sarcomas (accessed July 2023)

UK guidelines for the management of bone sarcomas, Clinical Sarcoma Research (2016) 6:7. Gerrand C et al on behalf of the British Sarcoma Group. Available at: UK guidelines for the management of bone sarcomas - PMC (nih.gov)(accessed July 2023)

British Medical Journal, BMJ Best Practice. Osteosarcoma. Last updated May 2022. Last reviewed 27 Jun 2023. Available at: Osteosarcoma - Symptoms, diagnosis and treatment | BMJ Best Practice (accessed July 2023)

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by senior medical editor Fiona Cowie, Consultant Clinical Oncologist.

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