Orthopaedic Oncology Service
Mass General - Boston
55 Fruit Street
Yawkey Building, Suite 3B
Boston, MA 02114
Explore Adjuvant Therapy
Chemotherapy is drug treatment given in pill, injection and intravenous forms to kill cancer cells. This may lead to shrinkage of the tumor, but chemotherapy is primarily aimed at preventing the cancer from spreading. Since chemotherapy can be harsh on the veins in your arm, most patients have a central venous catheter (Broviac/Hickman or Portacath) placed in a large vein in their chest through which the drugs are administered. Length of treatment depends on the type of cancer and what research studies have shown to be the best time periods.
Common side effects include fatigue, hair loss, mouth sores, low blood counts and fever.
Fatigue is very frustrating for our patients because it prevents them from working, helping with household chores or doing activities they once enjoyed. Blood counts usually drop (nadir) seven to fourteen days after a chemotherapy treatment. Some patients develop fever and are susceptible to infection (neutropenia). Patients are usually admitted to the medical oncology service for close monitoring when they are neutropenic and receive intravenous antibiotics with possible blood transfusions (red cells, white cells or platelets).
Hair loss is traumatic for most of our patients. Loosing clumps of hair is physically annoying and overwhelming to look at. Some patients shave their head to avoid the sporadic itchy clumps. Many patients get wigs, others use hats or turbans, and many remain naturally bald. It is important to remember that the hair will grow back after completion of the chemotherapy.
We advise patients to talk with other patients receiving chemotherapy for only they know what the experience is truly like. It is important to remember that each sarcoma has a personality of its own, behaving differently in each patient, as do the side effects of chemotherapy treatment.
Chemotherapy protocols vary in length of treatment. Most protocols have an outline (schema) of the treatment plan. Ask your oncologist for a copy so that you have an idea about the schedule for hospitalizations or outpatient clinic treatments.
An example of a protocol for bone cancer (osteosarcoma) is as follows: Combination Chemotherapy and Radiation: Large malignant soft tissue sarcomas greater than 8 centimeters in size are treated with both chemotherapy and radiation before they are surgically removed. This therapy is called the MAID protocol. Radiation is sandwiched in between cycles of chemotherapy to hopefully reduce the size of the tumor, cause death (necrosis) of tumor cells, and prevent spread of tumor cells (metastasis).
You may need an implanted port as part of your chemotherapy treatment. A port is a special type of intravenous (IV) device. It is a small, hallow disk with a catheter attached to it. The catheter is tubing that goes inside your body. It is inserted in a large vein just under your collarbone.
The port is small, firm and a little larger than a quarter.
It is placed in a pocket of tissue just beneath your skin.
Ports are usually place in the upper part of your chest, over your ribs and just below your collarbone. You will feel a firm round bump just below your skin.
Ports are used because your treatment requires it or your veins are difficult to use for IV infusion. It will be used for giving you chemotherapy, IV fluids or medication.
Your nurse will place a special needle through your skin into the center of the port. This is called "accessing" the port. This allows your nurse to give you IV fluids, chemotherapy or medications.
Your port will be put in by a radiologist in Interventional Radiology. This is an outpatient procedure. You must be bring someone with you who can drive you home after the procedure. The medications you get for the procedure will make you too drowsy to drive.
The procedure will be done under local anesthesia. This means you will be awake during the procedure. You may receive medication through an IV to help you relax. You will have one small incision in your chest.
The port is placed in a pocket of fatty tissue just beneath your skin, and the catheter (internal tubing) is put in a large blood vessel under your collarbone.
The incisions will be closed with strips of paper tape and covered with a dressing. An x-ray is taken to make sure the port is in the correct place.
Radiation therapy uses high energy X-rays or particles to kill cancer cells. The radiation source may be external (from outside the body) and come from beams and X-rays aimed at the cancer; or, the radiation source may be internal (from inside the body) and come from radioactive implants. The goal of both external and internal radiation therapy is to kill the cancer cells while limiting the damage to healthy normal cells around the tumor. Most healthy cells that are damaged by the radiation can quickly repair themselves.
Radiation therapy is used:
- Alone, as the only treatment you need
- Before surgery to shrink the tumor
- During surgery to protect the area around the tumor
- After surgery to destroy any remaining cancer cells
- With chemotherapy, which makes the cancer cells more sensitive to radiation treatment
- After chemotherapy to kill remaining cancer cells
- To control symptoms such as pain or bleeding
The Department of Radiation Oncology developed a patient guide about radiation therapy, which provides more information about radiation treatment. There are many types of radiation therapy:
Intensity Modulated Radiation Therapy (IMRT)
A type of conformal radiation which shapes the radiation beam to approximately the shape of the tumor. IMRT enables a more precise conformal radiation dose distribution to the target area by allowing the physician to control the intensity of the radiation beam within a given area.
Pencil Beam Proton Therapy
A beam delivery technique that uses the proton beam and allows a "sweep" of protons across the treatment area maintaining conformality, the absence of an exit dose and reduction to dose to normal tissues.
Proton Beam Therapy
A type of radiation beam that limits the dose to the targeted area, thus sparing healthy tissues. Proton beam can be combined with conventional photon treatments.
Stereotactic Radiation Surgery (SRS)
High precision delivery of a single, high dose radiation treatment to a brain or spine tumor while sparing normal surrounding tissue. Special immobilization, imaging techniques, and equipment are used for this highly conformal treatment.
Stereotactic Radiation Therapy (SRT)
A high precision technique using a special head frame to immobilize and position patients during treatment delivery of certain brain tumors. Unlike SRS, SRT is delivered daily over several weeks.
Stereotactic Body Radiation Therapy (SBRT)
High precision delivery of high dose radiation over 2-5 treatments while sparing normal adjacent tissue. It is typically used for small lung and liver tumors. SBRT involves special patient immobilization and imaging techniques.
High Dose Rate Brachytherapy (HDR)
Procedure where doctors place a very high energy radiation source inside your body near the tumor site for a brief period of time. Healthy exposure to normal surrounding tissue can be minimized.
All types of radiation therapy can delay the wound healing process. Most often the wounds heal without difficulty but you should be aware that your incision may open and drain despite following all your doctor's restrictions on weight-bearing and range of motion. If your surgeon is concerned that would healing problems are likely, a plastic surgeon may be asked to move a muscle or flap from elsewhere to help with healing. If a wound problem develops, wet to dry packing of the wound is done daily, or twice daily which begins the slow process of healing (granulation). Many times wounds needs to be cleaned-up, which is called irrigation and debridement (I&D). Dealing with chronic draining open wounds that will not heal is mentally and physically exhausting. Some patients cope with this for as long as two years after their original surgery. On a more positive note, we have plenty of patients who will share with you their 'delayed wound healing experiences' because they have finally healed and have resumed normal daily activities.
The Mass General Cancer Center offers patients access to a wide variety of clinical trials of promising new therapies. Visit the Cancer Center's website to find open protocols for your type of cancer. To learn more about eligibility and participation call 877-726-5130.
The best resource for current information regarding all Clinical Trials for all types of cancer is clinicaltrials.gov.
Patients who take part in clinical trials are like pioneers. People take part for a number of reasons, but most hope they will help themselves today and others in the future. These volunteers are doing something extremely important to help future cancer patients.
Phases of a Clinical Trial
In phase I trials, researchers test for the first time, the safety of a new drug or dosage in people. Phase I trials usually include only a small group of 20 - 80 people. This type of study evaluates the treatment's safety and identifies side effects. Phase I trials are conducted to find the smallest dose that will likely be effective. They usually take place in special research institutions where patients can be closely monitored.
In phase II trials, the new drug or treatment is given in a larger group of people (100 - 300) to see if it is effective and to further evaluate its safety. Like phase I studies, phase II trials usually are conducted at special research institutions. In some phase II studies, patients may be randomly assigned to receive either the new treatment being studied or the standard treatment currently in use (this process is called randomization).
In phase III trials, the experimental study drug or treatment is given to even larger groups of people (1000 - 3000). During this phase, researchers are able to confirm the treatment's effectiveness, observe side effects that might not have occurred during earlier phases in smaller groups, compare the new treatment with currently used standard treatments, and collect information that will allow the new drug or treatment to be used safely.
In phase III studies, patients are randomly assigned to receive either the new treatment being studied or the standard treatment currently in use. There is good scientific reason why researchers use computers to randomize patients. They want to make sure there is no bias in the selection of who receives what treatment in the study. Only rarely does a cancer clinical trial involve a placebo (inactive treatment). They are only used when there is no standard treatment against which a new treatment can be compared
Phase III studies are often conducted in the community by local doctors in private practice or in small group hospitals, as well in special cancer centers. Through phase III trials, doctors can better understand how a treatment will work in the broader patient population.
In phase IV trials, researchers study drugs after they have been approved by the US Food & Drug Administration (FDA) and marketed to the public. Phase IV trials are designed to find out any additional information about the treatment's risks and benefits and the best way to use it. These studies help doctors understand the long-term safety and effectiveness of treatments.
In the future, researchers may be able to speed up research by combining some of the phases of clinical trials. That is because today, we know much more about cancer and the mechanisms that can lead to tumors. Some of these mechanisms are similar in a number of cancers, which may allow researchers to study large groups of people with different types of cancer. It would mean that developing new treatments would happen more quickly.
- Chief, Orthopaedic Oncology Service
- Director, Musculoskeletal Oncology Fellowship Program
- Associate Professor of Orthopaedic Surgery, Harvard Medical School
Santiago Lozano-Calderon, MD, PhD
- Orthopaedic Oncology Surgeon
- Assistant Professor of Orthopaedic Surgery, Harvard Medical School
- Orthopaedic Oncology Surgeon
- Instructor in Orthopaedic Surgery, Harvard Medical School
- Chief, Orthopaedic Spine Service
- Director, Spine Oncology & Co-Director, Stephan L. Harris Chordoma Center
- Associate Professor of Orthopedic Surgery, Harvard Medical School
- Nurse Practitioner; Doctor of Nursing; Clinical Director, Ortho Oncology; Director, Ortho APPs
- Inpatient Nurse Practitioner - Oncology
If you have any questions, please get in touch.