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Chemotherapy for childhood bone cancer

Chemotherapy uses anticancer, or cytotoxic, drugs to destroy cancer cells. Most children with bone cancer have chemotherapy. The healthcare team will consider your child’s needs to plan the drugs, doses and schedules of chemotherapy. Your child may also receive other treatments.

Chemotherapy is given for different reasons. Your child may have chemotherapy to:

  • destroy cancer cells in the body
  • shrink a tumour before other treatments such as surgery or radiation therapy (called neoadjuvant chemotherapy)
  • reduce the risk of the cancer recurring (called adjuvant chemotherapy)
  • relieve pain or control the symptoms of advanced bone cancer (called palliative chemotherapy)

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the bone. The drugs may be given by mouth or by a needle in a vein (intravenous injection). Sometimes a special device called a central venous catheter may be used to safely give the drugs. It is usually placed during surgery at the start of chemotherapy and left in place until treatment is finished. Find out more about central venous catheter.

Chemotherapy drugs used for osteosarcoma

The most common chemotherapy drugs used to treat childhood osteosarcoma are:

  • high-dose methotrexate
  • doxorubicin (Adriamycin)
  • cisplatin (Platinol AQ)

The most common chemotherapy combination used to treat childhood osteosarcoma is:

  • high-dose methotrexate, doxorubicin and cisplatin

Chemotherapy drugs used for Ewing sarcoma of the bone

The most common chemotherapy drugs used to treat childhood Ewing sarcoma of the bone are:

  • vincristine (Oncovin)
  • doxorubicin
  • cyclophosphamide (Cytoxan, Procytox)
  • ifosfamide (Ifex)
  • etoposide (Vepesid)

The most common chemotherapy combination used to treat childhood Ewing sarcoma of the bone is:

  • vincristine, doxorubicin, cyclophosphamide, etoposide and ifosfamide

Cyclophosphamide and ifosfamide can irritate the bladder. When these chemotherapy drugs are used, mesna (Uromitexan) is also given to protect the bladder.

Side effects

Side effects can happen with any type of treatment for childhood bone cancer, but every child’s experience is different. Some children have many side effects. Other children have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. Side effects can develop any time during, immediately after or a few days or weeks after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

It is hard to say exactly which side effects a child will have, how long they will last and when the child will recover. A child’s body seems to handle chemotherapy better than an adult’s body. Children usually have less severe side effects and will often recover from them faster than adults.

Side effects of chemotherapy will depend mainly on the type of drug or drugs given, the dose, how the drugs are given and the child’s overall health. Some common side effects of chemotherapy drugs used for childhood bone cancer are:

Sometimes side effects develop months or years after chemotherapy. Find out more about late effects of treatments for childhood bone cancer.

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.

Information about specific cancer drugs

The following websites have information about specific drugs used to treat cancer in children.

Cancer Care Ontario (CCO) Drug Formulary is a searchable database of drugs used to treat cancer.

British Columbia Cancer Agency (BCCA) Drug Index (Professional) is a list of drugs used to treat cancer and basic information about uses and doses.

Questions to ask about chemotherapy

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

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