Radiotherapy for primary bone cancer
Radiotherapy treats cancer by using high-energy rays that destroy the cancer cells while doing as little harm as possible to normal cells.
Radiotherapy works well for Ewing’s sarcoma and is often given together with chemotherapy and surgery. If surgery to remove the tumour is not possible, radiotherapy may be used as the main treatment.
If the tumour is in your spine or pelvis, radiotherapy may be used if your doctor thinks surgery to the area might cause a disability. Sometimes before the start of radiotherapy, the surgeon will carry out an operation to place a water-filled balloon into the pelvis. The balloon moves the organs in the pelvis out of the way of the radiotherapy beam. This protects them from any damage the radiotherapy may cause.
Radiotherapy isn’t often used to treat osteosarcoma, spindle cell sarcoma or chondrosarcoma, because these types of bone cancer aren’t very sensitive to radiation. However, radiotherapy may sometimes be used instead of surgery, if surgery isn’t advisable. Occasionally, radiotherapy may be given after surgery to destroy any cancer cells that remain in the surrounding tissues, or to reduce the chance of the cancer coming back.
How radiotherapy is given
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Treatment is usually given in the hospital radiotherapy department, every weekday, with a rest at the weekend. How long your treatment takes will depend on the type and size of the cancer, but it will normally be a few weeks. Your doctor will discuss your treatment with you beforehand.
Planning your treatment
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To make your radiotherapy as effective as possible, it must be carefully planned. On your first few visits to the radiotherapy department you’ll usually be asked to have a CT scan, which will take images of the area to be treated. The planning will be done by a clinical oncologist and medical physicist or radiographer, and may take up to a few visits.
Marks may be drawn on your skin to help the radiographer, who gives you your treatment, to position you accurately. They also show where to direct the rays. These marks must stay visible throughout your treatment, but they can be washed off once it is over. Often two or more tattoo marks are also made on the skin. These are permanent, but they are the size of a pinpoint and will only be done with your permission. It’s a little uncomfortable while the tattoo is being done, but it’s a good way of making sure that treatment is directed accurately.
At the beginning of your radiotherapy you’ll be told how to look after the skin around the area to be treated.
Before each session of radiotherapy the radiographer will position you carefully and make sure that you’re comfortable. Treatment only takes a few minutes. During treatment you’ll be left alone in the room, but you can talk to the radiographer who will be able to see you from the next room. Radiotherapy is not painful, but you do have to lie still for a few minutes while it is being given.
Side effects of radiotherapy
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Side effects following radiotherapy treatment will depend on the area being treated. The side effects can be mild or more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. The radiotherapist will be able to advise you about what to expect. Some general side effects include tiredness, feeling sick, sore skin and hair loss in the area being treated.
Radiotherapy doesn’t make you radioactive. It’s safe for you to be with other people, including children, throughout your treatment.
Radiotherapy can make you tired so you may need more rest than usual, especially if you have to travel a long way for treatment every day.
Nausea can usually be effectively treated by anti-sickness drugs (anti-emetics). Your doctor can prescribe them for you. If you don’t feel like eating, speak to your nurse or ask to see a dietitian for advice. We have more information on eating well during cancer treatment.
Some people develop a skin reaction while having radiotherapy. If this affects you, it will normally happen after 3-4 weeks. People with pale skin may find that the skin in the treatment area becomes red and sore or itchy. People with darker skin may find that their skin becomes darker and can have a blue or black tinge. Your radiographers will be looking out for these reactions, and you should let them know if you notice any soreness or change in skin colour. They will be able to give you advice on how to look after your skin in the area being treated.
Radiotherapy can make your hair fall out in the area being treated. It may grow back after treatment is over, but for some people the hair loss is permanent. This depends on the total dose of radiotherapy that is given. Your doctor can tell you whether your hair is likely to grow back after treatment.
All these side effects should disappear gradually once your course of treatment is over, but it’s important to let your doctor know if they continue. We have more information and a video about radiotherapy its side effects.