Bone cancer presents a complex challenge in oncology, demanding a multifaceted approach to treatment and care. From traditional surgical interventions aimed at tumour removal to emerging immunotherapy and innovative ablative techniques, the landscape of bone cancer treatment continues to evolve. This blog explores the diverse bone tumour treatment modalities available and sheds light on the role of supportive care and palliative treatment in enhancing a patient’s quality of life.
The choice of bone cancer treatment approach depends on various factors, including the type, location, and stage of the cancer, as well as the patient's overall health and preferences. Oncologists often combine various procedures for effective results.
Surgical Treatments for Bone Cancer
Surgical treatments for bone cancer aim to remove the part of the bone affected by the cancer. Here are some common surgical options used for bone cancer treatment:
- Limb-sparing Surgery: Whenever possible, surgeons aim to remove the cancerous tumour while preserving as much of the surrounding healthy bone and tissue as possible. This approach is known as limb-sparing surgery. It involves removing the tumour along with a margin of healthy tissue around it to ensure all cancer cells are removed. After the tumour is excised, the bone may be reconstructed using bone grafts, metal implants, or other techniques to restore function and stability to the limb.
- Amputation: In cases where limb-sparing surgery is not feasible, such as when the tumour is too large or has spread extensively within the bone, amputation may be necessary. This involves surgically removing part or all of the affected limb to remove the cancerous tissue. Artificial limbs are used by most patients after the procedure.
Some surgeries are done after the primary treatment for bone cancer. These may be done to stabilise weakened bones or replace bones that have been removed in surgery.
- Bone Grafts: In some cases, bone grafts may be used to replace bone that has been removed during surgery. Bone grafts can be taken from other areas of the patient's body (autograft) or from a donor (allograft). The graft helps to fill the void left by the removed tumour and promotes bone healing and regeneration.
- Stabilisation Surgery: In cases where the bone weakened by cancer is at risk of fracture or collapse, stabilisation surgery may be performed to reinforce the bone and prevent further damage. This may involve the use of internal fixation devices such as plates, screws, or rods to support the bone and promote healing.
- Palliative Surgery: In some situations, surgery may be performed to alleviate bone cancer symptoms and improve quality of life rather than to cure the cancer. This could involve removing part of the tumour to relieve pain or reduce pressure on surrounding tissues.
It's important to note that surgery is often used in combination with other treatments, such as chemotherapy, radiation therapy, or targeted therapy, to achieve the best possible outcome for patients with bone cancer. The choice of treatment depends on the specific characteristics of the cancer and the individual patient's needs and preferences.
Non-surgical Treatments for Bone Cancer
Non-surgical treatments for bone cancer, including chemotherapy, radiation therapy, and targeted therapy, offer diverse options for management. Here, we explore non-surgical treatments, their associated side effects, as well as their efficacy individually and in combination with other approaches for effective bone cancer management.
1. Chemotherapy
Chemotherapy uses drugs to kill cancer cells or stop them from growing. These drugs, which can be administered orally or intravenously, circulate throughout the body, targeting cancer cells wherever they may be. In bone tumour treatment, chemotherapy is often used in combination with surgery and/or radiation therapy, especially for cancers that have spread beyond the bone.
Common drugs used and their side effects:
- Methotrexate: This drug works by interfering with the growth of cancer cells. It is used along with doxorubicin and cisplatin to treat osteosarcoma and spindle cell sarcomas. Side effects can include nausea, vomiting, hair loss, decreased blood cell counts, and mouth sores.
- Doxorubicin (Adriamycin): Doxorubicin is a chemotherapy drug used for Ewing sarcoma treatment and for osteosarcoma and spindle cell sarcomas when used in combination with methotrexate and cisplatin. It can cause side effects such as hair loss, nausea and vomiting, mouth sores, and an increased risk of infection due to decreased blood cell counts.
- Cisplatin: Cisplatin is another chemotherapy drug used in combination with methotrexate and doxorubicin for osteosarcoma and spindle cell bone cancer. It can cause side effects including nausea, vomiting, kidney damage, and hearing loss.
- Ifosfamide: Ifosfamide is used for ewing sarcoma, or cancer that has come back. It can cause side effects such as nausea, vomiting, hair loss, and decreased blood cell counts. It can also affect kidney function.
2. Radiation Therapy
Radiation therapy uses high-energy radiation beams to kill cancer cells or shrink tumours. It can be used as a primary treatment for bone cancer or in combination with surgery and/or chemotherapy. Radiation therapy aims to target and destroy cancer cells while minimising damage to surrounding healthy tissue.
Side Effects and Considerations
- Common side effects of radiation therapy for bone cancer may include fatigue, skin irritation or burns at the site of treatment, nausea, and hair loss in the treatment area.
- Radiation therapy may also increase the risk of developing long-term side effects such as bone damage, joint stiffness, and secondary cancers in the treated area.
3. Targeted Therapy
Targeted therapy involves using drugs or other substances to specifically target cancer cells while minimising damage to normal cells. These drugs work by interfering with specific molecules involved in cancer cell growth and survival. In bone cancer treatment, targeted therapy may be used to treat certain types of bone cancer or cancers that have specific genetic mutations.
Examples of Targeted Therapy Drugs
- Denosumab (Xgeva): Denosumab is a targeted therapy drug used to treat bone metastases from solid tumours, including large cell bone cancers, cancers that are too big to be removed by surgery, and cancers that have come back after surgery. It works by inhibiting a protein called RANKL, which plays a role in bone breakdown. Side effects can include low calcium levels, fatigue, and joint or muscle pain.
- Pazopanib (Votrient): Pazopanib is a targeted therapy drug that inhibits the growth of chemical messengers in cells, which can help slow the growth of tumours. It is used to treat certain types of bone sarcomas. Side effects can include high blood pressure, nausea, diarrhoea, and fatigue.
These non-surgical treatments are often used alone or in combination to effectively manage and treat bone cancer, depending on the specific type and stage of the cancer as well as individual patient factors.
Emerging and Innovative Treatments
1. Immunotherapy for Bone Cancer
Immunotherapy employs the body's immune system to combat cancer, showing promise across various cancer types. While its effectiveness in bone cancer is still being investigated, ongoing clinical trials explore agents like checkpoint inhibitors and CAR T-cell therapy. These treatments aim to leverage the immune system to target cancer cells while preserving healthy tissue.
2. Radiofrequency Ablation (RFA) and Cryoablation
RFA and cryoablation offer minimally invasive alternatives for bone cancer treatment when surgery isn't feasible or complete tumour removal isn't possible. By using heat or extreme cold to destroy cancer cells, these techniques precisely target tumours while minimising damage to surrounding tissue. Guided by imaging technology, such as CT or ultrasound, they provide accurate treatment delivery.
These emerging treatments provide novel strategies for bone cancer management, showing potential to enhance patient outcomes and quality of life. While further research and clinical trials are necessary to fully understand their effectiveness and potential side effects, patients should consult with their doctors to explore these options, taking into account their benefits and risks for their health condition.
Supportive Care and Palliative Treatment
Supportive care and palliative treatment play crucial roles in the comprehensive bone cancer treatment approach, particularly in improving quality of life, managing symptoms, and providing emotional and spiritual support for patients and their families. Here are some key aspects:
- Pain Management: Using medications, physical therapy, and alternative techniques to alleviate pain.
- Physical Therapy and Rehabilitation: Helping patients maintain or improve mobility and function.
- Nutritional Support: Ensuring adequate nutrition through diet, supplements, or tube feeding.
- Psychosocial Support: Providing counselling, support groups, and assistance with emotional and practical issues.
- Symptom Management: Addressing fatigue, nausea, constipation, and other symptoms with medication and supportive therapies.
- Advance Care Planning: Discussing and documenting preferences for end-of-life care.
- Hospice Care: Offering comprehensive support for comfort and quality of life in the advanced stages of the disease.
Last Word
The choice of treatment for bone cancer is influenced by a multitude of factors, including the patient's overall health, the type and stage of cancer, and personal preferences. Additionally, practical considerations such as accessibility, potential side effects, and bone cancer treatment costs in India play a significant role in decision-making. Therefore, it is essential for patients to engage in open consultations with their doctors to weigh these factors and make decisions that align with their individual needs and circumstances.
Disclaimer:
This article has been written for information purposes only, and is not a substitute for professional medical advice by a qualified doctor or other health care professional. The author is not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by the information in this article. Always consult a qualified healthcare provider for accurate diagnosis, personalised treatment, and recommendations tailored to your individual health needs.