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Osteosarcoma is often treated with a combination of chemotherapy and surgery or radiation, depending on the outcome of surgery or the location of the tumor.

More information on how osteosarcoma is treated can be found in Treating Osteosarcoma.

Treatment of chondrosarcomas is based mainly on:

• The grade of the cancer, meaning how likely it is to grow and spread quickly based on how it looks under a microscope. Most chondrosarcomas are lower-grade tumors.
• The type of chondrosarcoma.
• The location of the cancer.
• Whether the cancer has spread outside the bone where it started.

Surgery is usually the first treatment used. Depending on the factors listed above, radiation, chemotherapy, or targeted therapies may also be used.

Surgery

Once a biopsy of the tumor confirms the diagnosis, surgery to remove the tumor is typically the first treatment.

For low-grade chondrosarcomas confined to an arm or leg bone:

Curettage might be an option. This is a procedure where the tumor is scraped out of the bone with a surgical tool called a curette.

The area where the tumor has been removed might then be treated with a chemical, such as phenol, or with extreme cold (cryotherapy) to try to kill any remaining cancer cells. The hole in the bone is then filled in with bone cement or a bone graft.

If curettage isn’t an option, a wide excision (either limb-sparing surgery or amputation) will be needed.

For low-grade chondrosarcomas in other bones and for all higher-grade chondrosarcomas:

More extensive surgery will likely be needed. Limb-sparing surgery might be an option for tumors in the arm or leg bones, although sometimes amputation might be a better option to completely remove the cancer.

For hard-to-treat chondrosarcomas:

Some chondrosarcomas, like those in the skull, can be hard to treat. They are often hard to remove completely with surgery, which might cause serious side effects. Some low-grade tumors can be treated with curettage.

For chondrosarcomas that have spread to other parts of the body:

If the tumors are small, they can also be removed with surgery.

Radiation therapy

For tumors that are harder to remove completely, such as those in the skull bones, radiation therapy might be given before and/or after surgery. Radiation can also be used if surgery can't be done for some reason.

Chondrosarcoma cells aren’t killed easily by radiation, so high doses are needed. Techniques such as intensity-modulated radiation therapy (IMRT) or proton beam radiation are likely to work best for these tumors.

Chemotherapy

Chemotherapy (chemo) isn’t usually very effective against chondrosarcoma cells, so it’s not often used to treat this type of cancer. Still, chemo can be used to treat some uncommon types of chondrosarcoma. For example:

• Dedifferentiated chondrosarcoma is often treated like osteosarcoma, with chemo given first, followed by surgery and then more chemo.
• Mesenchymal chondrosarcomas are often treated the same way as Ewing sarcoma. Treatment typically includes chemo, surgery, and radiation therapy.

Targeted therapy

Targeted therapies can be used to treat chondrosarcomas with certain gene changes or help control symptoms in cases where the tumor has spread throughout the body.

The treatment of these types of tumors may include drugs like dasatinib, pazopanib, or ivosidenib depending on the type of chondrosarcoma, the extent of the tumor, and whether gene changes are present or not. Targeted therapy can also be combined with immunotherapy in certain circumstances. For example, dedifferentiated chondrosarcoma can be treated with sunitinib and nivolumab.

Ewing sarcoma is often treated with a combination of chemotherapy and surgery or radiation, depending on the outcome of surgery and the location of the tumor.

More information on how Ewing sarcoma is treated can be found in Treating Ewing Sarcoma.

Often, these tumors are treated like Ewing sarcoma. In some cases, they may be treated with treatments used for soft tissue sarcomas.

These tumors are rarer than Ewing sarcoma. Researchers are studying the response to these and other treatments.

This cancer was previously known as malignant fibrous histiocytoma (MFH) of bone. It is treated mostly the same as osteosarcoma, with a combination of chemotherapy and surgery.

Chemotherapy is usually given first to shrink the tumor and try to kill any cancer cells that might have spread. Then the tumor and some surrounding normal tissue is removed with surgery. The type of surgery will depend on the location of the tumor and other factors.

After the cancer is removed, the bone may be reconstructed with a bone graft or some type of man-made prosthesis. In some cases, chemotherapy is also given after surgery.

For more on how osteosarcoma (and therefore UPS) is treated, see Treating Osteosarcoma.

Surgery is usually the first treatment for fibrosarcoma of the bone. Radiation and/or chemotherapy may also be used, depending on the outcome of surgery and how likely it is that the cancer could spread.

Surgery

Surgery is usually the main treatment for this type of bone cancer. The goal is to remove the tumor and a margin of surrounding normal bone. The type of surgery will depend on the location of the tumor and other factors.

Radiation therapy

These tumors tend to come back in the same place they started, so radiation therapy may be given after surgery to try to keep this from happening. Radiation might also be given if the cancer can’t be completely removed or if the doctor suspects some cancer might have been left behind.

Radiation can also be used if a fibrosarcoma returns after surgery.

Chemotherapy

Chemotherapy might also be part of treatment for these cancers, because they share some features with osteosarcomas and undifferentiated pleomorphic sarcomas. Drugs like doxorubicin, ifosfamide, and dactinomycin have been tried. However, these are rare tumors, so using chemo against them hasn’t been well studied.

These tumors don’t usually spread to other parts of the body, but they are sometimes hard to remove completely.

When possible, giant cell tumors of the bone are removed with surgery. If the tumor can’t be removed completely, other treatments are sometimes tried such as:

• Blocking blood vessels to the tumor, called arterial embolization
• Treatment with drugs like denosumab

Radiation treatment

This rare type of bone tumor most often occurs in either the base of the skull or in the lower bones of the spine. It tends to grow slowly and doesn’t often spread to other parts of the body, but it can be hard to remove completely, and it often comes back where it started.

Surgery

Surgery is usually the main treatment for these tumors. The type of surgery depends on where the tumor is.

For tumors in the spine, the tumor is removed along with some nearby normal tissue. This is known as a wide excision. It might not be possible to remove all of the tumor in some cases, such as if the spinal cord and nearby nerves are involved.

Tumors at the base of the skull are often hard to remove completely because they’re close to important parts of the brain like the brainstem and spinal cord. Curettage is often done to remove as much of the tumor as possible. This is a procedure where the tumor is scraped out of the bone with a surgical tool called a curette. It might be done through an incision (cut) in the skull or through a small hole created in the back of the nose.

Radiation therapy

Radiation therapy is often given after surgery to lower the chance that the tumor will grow back. Doctors typically use techniques that allow them to control the radiation very precisely, such as proton beam radiation or intensity-modulated radiation therapy (IMRT).

Radiation therapy may also be used if the tumor can’t be removed with surgery for some reason.

Targeted therapy

Newer targeted drugs might be helpful in treating some of these tumors if they come back after treatment. These drugs, or combinations of drugs, include:

• Imatinib +/- sirolimus
• Sorafenib
• Sunitinib

Chemotherapy

Chemotherapy usually isn’t effective for chordomas.