Bone cancer treatment: surgery, radiotherapy and chemotherapy, drugs

Effective treatment of bone tumours requires interdisciplinary collaboration.

The multidisciplinary approach involves paediatricians, general practitioners, orthopaedists, pathologists, oncologists, radiologists and specialists in rehabilitation and physiotherapy.

The treatment of musculoskeletal tumours itself has seen advances and changes in approach over the last 40-50 years. This has improved the chance of survival and prognosis for patients.

New insights into malignant cell transformation provide therapeutic opportunities for genetic engineering.

The goal of treatment regimens is radical removal of the primary tumor. It is often performed in combination with systemic chemotherapy and/or radiotherapy.

Often, so-called neoadjuvant chemotherapy is administered prior to surgery to shrink the tumour.

The surgical approach may require the cooperation of an orthopaedic surgeon and a vascular surgeon, thoracic surgeon or plastic surgeon. Incomplete removal of the tumour leaves a high risk of recurrence.

Surgical techniques have advanced considerably. Don't immediately imagine a radical amputation.

For tumours of the limbs, most patients are able to undergo what is known as limb-sparing surgery. In this operation, the affected part of the bone is removed down to the healthy tissue and replaced with a prosthesis. After surgery, thorough rehabilitation of the patient is very important.

In some patients, amputation of the limb may be necessary. Most often, these are patients with a large tumor or an aggressive, rapidly spreading tumor that cannot be safely removed.

The chemotherapy drugs used include methotrexate, doxorubicin, cisplatin, carboplatin, ifosfamide, topotecan, etc. They are administered according to standard international protocols according to the specific type of tumour.

Radiotherapy has an important role in the treatment of bone cancer (e.g. helping to eliminate residues after surgery) and in the prevention of complications. Its therapeutic use in the initial treatment is limited in some types. For example, osteosarcoma is highly radioresistant.

Therapy of bone metastases also requires a multidisciplinary approach.

Bone metastases, if there is no spinal cord compression or pathological fracture, can be significantly influenced by anticancer and antiresorptive therapy. In this way, patients' mobility and self-sufficiency are preserved.

A better prognosis is achieved if a large number of bone metastases are not present, if they are not associated with metastases to other systems and if a primary tumour bed is identified.

Bisphosphonates (e.g. pamidronate, zoledronic acid etc.) and targeted treatment with the monoclonal antibody denosumab, analgesics, radioisotopes, external beam radiotherapy, orthopaedic and surgical interventions are used in the treatment of bone metastases.