Radiotherapy for bone cancer

You may have radiotherapy as part of your treatment for primary bone cancer. This uses high-energy rays to destroy cancer cells in the bone. It is generally only used to treat Ewing sarcoma.

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 generally used to treat Ewing sarcoma. It is often given together with chemotherapy and surgery.

Radiotherapy can be given either before or after surgery. If it is not possible to have surgery to remove the cancer, radiotherapy may be used as the main treatment.

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

Radiotherapy for bone cancer can be given in different ways.

  • Intensity modulated radiation therapy (IMRT)

    This type of radiotherapy is often used to treat primary bone cancer. IMRT gives the cancer a high dose of radiation and changes the dose given to nearby healthy tissue. This can help reduce side effects.

  • Proton beam therapy

    This treatment uses proton radiation to destroy cancer cells, instead of x-rays. The proton beam is aimed directly at the cancer, so it causes very little damage to nearby healthy tissue. It is sometimes used to treat primary bone cancer in children. It is also used to treat cancer in the spine or base of the skull. We have more information about proton beam therapy.

Planning your radiotherapy

Before you start your treatment, it needs to be planned. This is to make sure the radiotherapy is aimed directly at the cancer. This also means it causes the least possible damage to nearby healthy tissue.

Radiotherapy is planned by the radiotherapy team. Planning is important and may take a few visits. For primary bone cancer, planning may involve:

  • Radiotherapy moulds

    If you are having radiotherapy to a limb, you may have a mould made of your limb. This helps keep it in the same position every day for radiotherapy. It is made on your first visit to the radiotherapy department. Your cancer doctor or specialist nurse will tell you more about moulds if you need one.

  • 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 (tattoos) are made on the skin. They will only be done with your permission. It can be uncomfortable while the tattoo is being done.

  • Radiotherapy to the pelvis

    Before radiotherapy to the pelvis, some people have a small operation. The surgeon puts a ‘spacer’ inside the tummy (abdomen). This moves the organs out the way of radiotherapy to protect them from any damage. Your cancer doctor will tell you more about this operation if it is needed.

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.

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 with you about the treatment and possible 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 you were in 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. These side effects will slowly disappear over a few weeks or months after treatment finishes.

Your cancer doctor, specialist nurse or radiographer will talk to you about this, 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.

Stiffness and swelling

If you have radiotherapy to a limb, it can get swollen and stiff. Talk to your cancer doctor if you notice this. They can prescribe painkillers to help.

Tiredness (fatigue)

Tiredness is a common side effect and may continue for months after treatment finishes. During treatment, you may need to rest more than usual, especially if you need to travel a long way for treatment each day. But it is good to do gentle exercise, such as walking, when you feel like you can. This can help boost energy and improve your general well-being.

After your treatment finishes, slowly increase your activity and try to balance rest periods with some physical activity. This will help you build up your energy levels.

Feeling sick (nausea)

Some people find their treatment makes them feel sick (nauseous) and sometimes be sick (vomit). This is most common when the treatment area is near the tummy area and pelvis. If you have nausea and vomiting, they can often be treated with anti-sickness drugs (anti-emetics). Your cancer doctor can prescribe these for you.

If you are not hungry, you can replace meals with special high-calorie drinks. These are available from most chemists and can be prescribed by your GP. To stop you becoming dehydrated, it is important to keep drinking water. It can help to sip drinks slowly if you feel sick. It is important to eat and drink well during treatment. This will help you cope with and recover from the radiotherapy.

Skin reaction

You may find your skin in the treatment area becomes red or darkens. It may also feel sore or itchy. Sometimes the skin gets very sore and it may blister, break or leak fluid. Very rarely, treatment may be stopped for a short time to allow a serious skin reaction to recover.

Skin reactions can take time to improve. They are usually better by about 4 weeks after you finish treatment. 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.