Chemotherapy for Bone Sarcoma

NYU Langone sarcoma specialists pioneered the use of chemotherapy before surgery in the treatment of adult bone sarcoma, making them leaders in the medical management of these cancers.

Chemotherapy given beforehand, also called neoadjuvant chemotherapy, may be used when surgery is not feasible because of the large size or location of a tumor. Neoadjuvant chemotherapy may help to shrink the tumor, making surgery possible.

Chemotherapy may occasionally be given after surgery, referred to as adjuvant chemotherapy, to ensure that a bone sarcoma has not spread anywhere else in the body.

Doctors typically use chemotherapy to treat people with bone sarcoma when diagnostic tests show that the person has a higher risk of the cancer coming back after treatment, or if the cancer has already spread to other parts of the body. At NYU Langone, our doctors may also use chemotherapy to manage lower- or standard-risk tumors to increase the effectiveness of treatment.

Chemotherapy is used to treat people with osteosarcoma, a cancer that starts in the bone cells, before and after surgery. Treatment before surgery is meant to destroy any microscopic tumor cells that may have traveled in the blood to other parts of the body. Doctors may also use chemotherapy before surgery if imaging tests show that cancer has already spread to organs such as the lungs.

If your treatment plan includes limb-sparing surgery for osteosarcoma in the arm or leg, your doctor may recommend neoadjuvant chemotherapy to shrink the tumor prior to surgery, making the procedure easier. Your doctor may also recommend chemotherapy after surgery to manage any remaining cancer and to reduce the risk of it coming back.

Typically, people with Ewing sarcoma, another type of bone cancer, are treated with neoadjuvant chemotherapy to kill any cancer cells that may be circulating in the blood or that have spread to other parts of the body. Chemotherapy may be combined with radiation treatment to reduce the chance of the cancer coming back after surgery.

Chemotherapy is usually not effective for most chondrosarcoma tumors. However, our doctors are experts in determining which subtypes of chondrosarcoma benefit from chemotherapy. Surgery, sometimes followed by radiation therapy, is often the preferred treatment for chondrosarcoma.

Sometimes chemotherapy is given to people with chordoma, a rare form of bone sarcoma, to help slow the progression of cancer. Radiation therapy may be used to manage chordoma after surgery, reducing the chance that any remaining tumor may grow.

Giant cell tumors may respond to a medication called denosumab, which is a monoclonal antibody drug, or a medication made of antibodies that target and help destroy substances in the body. Denosumab locks onto, or binds to, a particular molecule on the surface of the giant cells that is necessary for the cells to divide. This binding helps block their growth.

Denosumab may be used to shrink large giant cell tumors before surgery to help make the procedure easier. It can also be used to treat people with a giant cell tumor that spreads to the lung, although this is rare.

Chemotherapy side effects may include nausea, vomiting, diarrhea, and decreases in the levels of red and white blood cells. A low level of red blood cells, a condition called anemia, can lead to fatigue and shortness of breath. A low level of white blood cells can increase the risk of infection.

All of these side effects can be managed with medications or other therapies prescribed by your doctor. At NYU Langone’s Perlmutter Cancer Center, our specialists support you throughout chemotherapy, offering support groups and holistic wellness programs among others. Your doctor can evaluate your symptoms and connect you with the support services that best suit your needs.