The preferred curative treatment of primary bone cancer is surgery.

Background of the research:

The most common option for curative treatment of primary bone tumours is surgery. Although for some patients, in addition of chemotherapy, radiotherapy is needed, in addition or instead of surgery. This is particularly the case for patients with tumours located on the pelvis or the spine, where surgery may not be possible.

For Ewing’s sarcoma, surgery is the optimal local therapy, but radiotherapy can be used as a potentially curative treatment, when surgery cannot be used.For more radio-resistant bone tumours (osteosarcoma, chordoma, spindle cell sarcoma of bone) radiotherapy has often not been very effective, as it is difficult to deliver a high enough dose to kill the tumour without causing unacceptable side effects to nearby normal tissues.

In recent years, new radiotherapy technologies have been introduced to achieve better tumour control with less side effects, they are:

  • Intensity-modulated radiotherapy (IMRT), allows better shaping of a radiotherapy beam to treat the tumour more accurately, while sparing more normal tissue and hence reducing side effects.
  • Proton beam therapy (PT) uses heavy proton particles that travel through tissue and deposit their energy on a small focussed area, this allows high dose radiation treatment while leaving normal tissues unaffected.


The clinical fellowship funded by BCRT allowed the establishment of protocols and the assessment of these techniques in bone cancer patients. To determine if these methods can improve survival rates for patients that would respond best to IMRT or PT. An important objective was also to assess the effectiveness of these treatments in patients with inoperable primary pelvic or spinal bone cancer, to set national standards of radiotherapy care across the UK and reduce the risk of relapse.

When these techniques were applied to a group of young female Ewing sarcoma of the pelvis patients; both IMRT and PT resulted in excellent sparing of bowel, rectum, and bladder. PT offered superior sparing of the head of the femur, uterus, vagina, and ovaries. This approach may translate into a reduction in long term treatment related toxicity such as infertility, early menopause, and spontaneous fractures.

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