Chemotherapy for childhood bone cancer

Chemotherapy uses drugs to destroy cancer cells. These drugs target rapidly dividing cells throughout the whole body. This means that chemotherapy kills cancer cells but it can also damage healthy cells.

With most types of chemotherapy, the drugs travel through the blood to reach and destroy cancer cells all over the body, including cells that may have broken away from the primary tumour. This is described as systemic therapy.

Most children with bone cancer have chemotherapy. Your child’s healthcare team will use what they know about the cancer and about your child’s health to plan the drugs, doses and schedules. Chemotherapy is usually used along with other cancer treatments, such as surgery. Chemotherapy may be used to:

• shrink a tumour before other treatments such as surgery (called neoadjuvant chemotherapy)
• destroy cancer cells left behind after surgery to reduce the risk that the cancer will come back (called adjuvant chemotherapy)
• relieve pain or control symptoms of advanced and metastatic childhood bone cancer (called palliative chemotherapy)

Chemotherapy may affect how puberty develops in children. It can eventually affect their fertility, which is the ability to get pregnant or get someone pregnant. Talk to the healthcare team about fertility options before treatment begins.

The drugs may be given by mouth (orally) or by a needle in a vein (intravenously, or by IV).

Usually, a special device called a central venous catheter is used to give the drugs safely. It is a thin, flexible tube that is inserted into a vein in the neck, chest or arm. It’s put in place at the start of chemotherapy and left in until treatment is finished. Find out more about a central venous catheter.

The most common chemotherapy drug combination used for osteosarcoma includes high-dose methotrexate, doxorubicin and cisplatin (MAP).

Other chemotherapy drugs used to treat osteosarcoma are:

• ifosfamide
• cyclophosphamide
• etoposide
• carboplatin

The most common chemotherapy drug combination for Ewing sarcoma includes vincristine, doxorubicin and cyclophosphamide, alternating with a combination of ifosfamide and etoposide.

If Ewing sarcoma doesn’t respond to drugs used in earlier treatments, or if it comes back, the following drugs may be used:

• irinotecan
• temozolomide
• topotecan
• gemcitabine
• docetaxel
• carboplatin

If ifosfamide or cyclophosphamide is used, then mesna is given at the same time. Mesna is a supportive drug used to protect the bladder from damage and lower the risk of urinary tract problems caused by these chemotherapy drugs.

If doxorubicin is used, then dexrazoxane is given at the same time. Dexrazoxane is used to protect the heart from damage caused by this chemotherapy drug.

The side effects of chemotherapy will depend mainly on the drug, the dose, how it’s given and your child’s overall health. Tell the healthcare team if your child has any side effects you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help your child deal with them.

Common side effects of chemotherapy for childhood bone cancer include:

• low blood cell counts
• low white blood cell counts (neutropenia)
• infection
• low platelet counts
• low red blood cell counts (anemia)
• nausea and vomiting
• loss of appetite
• taste changes
• fatigue
• hair loss
• skin problems
• a sore mouth or throat
• diarrhea
• constipation
• bleeding

Other side effects can develop months or years after treatment for childhood bone cancer. These are called late effects. Find out more about the late effects of treatments for childhood bone cancer.

Find out more about chemotherapy and the side effects of chemotherapy. To make the decisions that are right for your child, ask the healthcare team questions about chemotherapy.

Details on specific drugs change regularly. Find out more about the sources of drug information and where to get details on specific drugs.