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Making the Decision to Have Radiation Therapy for Primary Bone Cancer

Radiation therapy is also called radiotherapy. Its goal is to use radiation, or high-energy X-rays, to kill or shrink cancer cells while doing as little harm as possible to normal cells. The treatments are typically delivered on a set schedule over a specific period of time. Radiation therapy is rarely the preferred course of treatment in primary bone cancers, but your doctor may suggest it in any of these cases:

  • You have Ewing sarcoma.

  • You are too sick for surgery.

  • Surgery can't remove the cancer completely because of the location of the tumor.

  • Your doctor wants to try to shrink the tumor before surgery to make the operation easier.

  • You've already had surgery for bone cancer, and your doctor wants to use radiation to kill any remaining cancer cells.

  • The cancer cannot be cured, but your doctor wants to use radiation to ease your pain.

 If you have Ewing sarcoma, your doctor may use radiation as part of your treatment. This type of bone cancer usually responds well to radiation.

If you have osteosarcoma, usually your doctor does not use radiation to treat it. However, if the  tumor can't be removed completely with surgery, radiation may be given afterward to try to kill any remaining cancer cells. Radiation may also be used to help control pain or other symptoms if the cancer has spread and surgery is not possible.

Some people with chondrosarcoma have radiation if surgery can't remove the tumor.

What happens during radiation treatment

Before getting radiation, you will talk with a doctor who specializes in both cancer and radiation. This doctor is called a radiation oncologist. You'll find out what type of radiation you need, at what dose, and for how long.

Most people with bone cancer will get external radiation. This type of radiation comes from a machine located outside of your body. It is sometimes called EBRT, which stands for external beam radiation therapy.

Some people get internal radiation, which is also called brachytherapy. For this treatment, the radiation oncologist places small catheters in the area where the tumor was removed by the surgeon. He or she inserts small seeds or pellets of radiation into the catheter and leaves them implanted in the targeted area for the amount of time your doctor determines you need. You may get this as well as EBRT.

Preparing for external radiation

Before your first treatment, you'll have an appointment to plan exactly where on your body the radiation beam needs to be directed. This process is called simulation. The appointment may take up to two hours. Here's what you can expect to happen:

  • You'll lie still on a table while a radiation therapist uses a machine to define your treatment fields. These are also called treatment ports. The field is the exact area on your body where the therapist will aim the radiation. You may have more than one treatment field if you have cancer in more than one place. The therapist marks your skin with tiny dots of colored ink to aim the radiation at the exact same place each time.

  • You may also have imaging scans to help doctors know the exact location of the tumor to better aim the radiation. This may include a computed tomography (CT) scan.

  • You'll receive a schedule for radiation therapy. The schedule is usually for five days a week for several weeks. Spreading out the radiation dose helps protect your healthy tissue.

During your visit, ask what you can expect to feel during and after the treatment.

On the days you get external radiation

You can receive EBRT as an outpatient. That means you may have it at a hospital or a clinic, but you don't have to stay the night. 

On the days you receive radiation treatment, you'll lie on a table with the machine above you. You may have to wear a hospital gown. The experience is like getting an X-ray, only it lasts longer. It will take about 15 to 30 minutes for the whole process. A radiation therapist may place blocks or special shields to protect parts of your body that don't need to be exposed to radiation. The therapist lines up the machine with your marked treatment areas.

The radiation therapist will leave the room to turn on the machine. You will be able to talk to the therapist through an intercom. You can't feel radiation. It will be painless. You may hear whirring or clicking noises. 


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