Chemotherapy for childhood bone cancer

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. Most children with bone cancer have chemotherapy. Your child's healthcare team will plan the drugs, doses and schedules of chemotherapy.

Chemotherapy may be given to:

• destroy cancer cells in the body
• shrink a tumour before other treatments such as surgery (called neoadjuvant chemotherapy)
• destroy cancer cells left behind after surgery and lower the risk that the cancer will come back (called adjuvant chemotherapy)
• relieve pain or control the symptoms of advanced 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. If possible, talk to the healthcare team about the treatment plan and fertility options before treatment begins.

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the blood to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour.

The drugs may be given by mouth (orally) or by a needle in a vein (intravenous injection).

Usually a special device called a central venous catheter is used to safely give the drugs. It is often put in place at the start of chemotherapy and left in place until treatment is finished. Find out more about a central venous catheter.

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

• high-dose methotrexate
• doxorubicin
• cisplatin
• ifosfamide (Ifex)
• cyclophosphamide (Procytox)
• etoposide (Vepesid)
• carboplatin

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

• high-dose methotrexate, doxorubicin and cisplatin

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

• cyclophosphamide
• doxorubicin
• etoposide
• ifosfamide
• vincristine

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 can happen with any type of treatment, but every child's experience is different. Some children have many side effects. Other children have few.

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:

• low blood cell counts (bone marrow suppression)
• low white blood cell count
• infection
• low platelet count
• anemia
• nausea and vomiting
• loss of appetite
• changes in taste
• fatigue
• hair loss
• skin problems
• sore mouth or throat
• diarrhea
• constipation

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

Tell your child's 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.

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

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