Bone Cancer
Radiation is one of the most dependable ways to take away pain caused by cancer in the bone. It also has a role in treating tumors that start in the bone itself.
About bone cancer
Two different situations get called bone cancer, and it helps to know which one you are dealing with. Primary bone cancer starts in the bone. It includes osteosarcoma, Ewing sarcoma, chondrosarcoma and chordoma. These tumors are uncommon, and care is usually shared between an orthopedic oncology surgeon, a medical oncologist and a radiation oncologist.
Far more often, cancer found in a bone began somewhere else and traveled there. This is called bone metastasis, and it is common in breast, lung, prostate, kidney and thyroid cancer, as well as multiple myeloma. The cancer is still named for where it started — breast cancer in the spine is treated as breast cancer, not as a new bone cancer.
For most people we see with cancer in the bone, the goal is comfort and function: less pain, a lower chance of the bone breaking, and protection for the spinal cord if the spine is involved. Radiation does that job well, and it usually does it quickly. Relieving bone pain is the single most common reason we treat this area.
Signs and symptoms
Bone pain is usually the first sign, and it tends to behave differently from an everyday ache.
- Deep, aching bone pain that is worse at night or when you are resting
- Pain that does not ease with rest and slowly gets worse over weeks
- Swelling, tenderness or a firm lump over a bone
- A bone that breaks after a minor fall, or with no injury at all
- New back or neck pain, especially with numbness, tingling or weakness in an arm or leg
- Trouble putting weight on a hip or leg
- Unexplained weight loss or unusual tiredness
When to call
These symptoms have many possible causes, most of them not cancer. But they are worth a conversation. If something has changed and hasn't resolved, contact your primary care physician — early evaluation is what makes treatment straightforward.
How we treat it
What we recommend depends on whether the cancer started in the bone or spread there. Primary bone tumors are often treated with surgery and chemotherapy, with radiation added when a tumor cannot be removed completely or sits somewhere surgery is difficult, such as the base of the spine. For cancer that has spread to bone, radiation is frequently the first thing we do, because it eases pain reliably and the course is short. We work closely with your medical oncologist, your surgeon and your pain team so the pieces fit together.
Palliative radiation for bone pain
This is the most common reason we treat bone, and it is very effective. A short course of external beam radiation is aimed at the painful area to shrink the tumor and calm the irritation it causes in the bone. Many people are treated in a single session or in five daily sessions, and relief often begins within one to three weeks. The goal is straightforward: less pain, fewer pain medicines, and getting back to moving comfortably.
External beam radiation therapy (EBRT)
EBRT delivers radiation from a linear accelerator outside the body. Nothing touches you and there is no incision or anesthesia. We use it for painful bone metastases, for bone that has weakened and is at risk of fracture, and after surgery to stabilize a bone. It is also used when a tumor is pressing on the spinal cord, where treating promptly helps protect strength and sensation.
Stereotactic body radiation therapy (SBRT)
SBRT concentrates a high dose into a tightly defined target over one to five sessions. In the bone we use it most often for tumors in or next to the spine, for people who have only one or a few sites of spread, and when an area needs treatment a second time. The steep drop-off in dose outside the target lets us stay away from the spinal cord.
Intensity-modulated radiation therapy (IMRT)
IMRT shapes the radiation beam so the dose wraps around an irregular target while staying off nearby structures. It is useful for bone tumors in the pelvis, the sacrum and the spine, where bowel, bladder, kidneys and nerves sit close by. We also use it for chordoma and other primary bone tumors that need a higher dose over a longer course.
Image-guided radiation therapy (IGRT)
IGRT is imaging taken on the treatment table, right before the beam turns on, so we can confirm your position within millimeters. It is built into the way we deliver both short palliative courses and SBRT. It adds a few minutes to each visit and it is the reason we can treat close to the spinal cord with confidence.
What treatment involves
Everything begins with a planning session called a simulation. You lie on a flat table while we take a CT scan in the exact position you will be treated in. If we are treating the spine or pelvis, we may make a custom cushion or mold to help you hold still comfortably. We place a few small marks on your skin so we can line you up the same way every day. Simulation takes about 30 to 45 minutes.
Your radiation oncologist and physicist then build and check your plan. For urgent pain or spinal cord compression, treatment can start within a day or two. For more involved plans, it usually takes several days.
Courses for bone pain are short. Many people are treated once. Others are treated five times over a week, or ten times over two weeks. SBRT is typically one to five sessions. Treatment for a primary bone tumor is longer, often several weeks of daily treatment Monday through Friday. Each visit runs about 15 to 30 minutes, and the beam itself is on for only a few minutes. You will not feel the radiation, and you can drive yourself home.
Possible side effects
Side effects are usually temporary and typically resolve shortly after treatment ends. Tell your care team about any discomfort — managing it is part of the treatment, not an interruption to it.
- Tiredness that builds over the course of treatment
- A brief flare of pain in the first few days before relief sets in — tell us, because we can treat it
- Mild redness, dryness or itching of the skin over the treated area
- Nausea, if we are treating the spine, ribs or pelvis near the stomach
- Loose stools or more frequent bowel movements when the pelvis is treated
- A sore throat or discomfort swallowing when the upper spine or neck is treated
- Lower blood counts if a large area of marrow is in the treatment field
Caring for yourself during treatment
- Rest when you need to, and don't hesitate to ask for help.
- Follow your care team's advice — and ask when anything is unclear.
- Tell us about every medication, vitamin and supplement you take.
- Eat a balanced diet and drink plenty of fluids.
- Treat skin in the treatment area gently: no sun, no hot or cold packs, and only lotions your team has approved.
- Lean on support groups, family and friends. Coping is part of treatment.
Trusted resources
- American Cancer Society — 1-800-227-2345
- National Cancer Institute — 1-800-422-6237
- Sarcoma Foundation of America — www.curesarcoma.org
- Multiple Myeloma Research Foundation — www.themmrf.org
- CancerCare — 1-800-813-4673
- RT Answers, American Society for Radiation Oncology — www.rtanswers.org
Clinical background adapted from materials by the American Society for Radiation Oncology (rtanswers.org) and the American Cancer Society.
Cancers We Treat
Talk to a Physician
Most new patients are seen within a few days of referral. Bring your questions — we'll make time for them.
Request an appointmentDiagnosed with bone cancer?
Talk with a board-certified radiation oncologist about whether radiation therapy belongs in your treatment plan.