Radiation Therapy for Chondrosarcoma

Chondrosarcoma is a rare form of cancer that can affect bones of the skull and spine. Without treatment, cancer cells can continue to grow and spread, causing damage to surrounding brain or nerves, and potentially leading to serious complications.

Fortunately, there are several treatment options available, including surgery, radiation therapy, and sometimes chemotherapy. Radiation therapy is often used as an adjuvant treatment for chondrosarcoma, meaning that it is used in combination with other treatments, like surgery. For example, radiation therapy can be used after surgery to destroy any remaining cancer cells and reduce the risk of a chondrosarcoma coming back.

Radiation therapy can also help in metastatic chondrosarcoma treatment. Chondrosarcoma is a type of cancer that can metastasize, or spread, to other parts of the body. In this case, radiation therapy may be used to shrink the tumor and slow the growth of cancer cells. For other patients who cannot undergo surgical removal of their chondrosarcoma, radiation therapy can be used as the primary treatment to reduce symptoms and improve quality of life.

Chondrosarcoma treatment guidelines will depend on your tumor’s location, size, and grade (low grade means slower growing and less likely to spread) and your overall health and medical history. Your neurosurgeon will consider all of these factors when creating a treatment plan for your chondrosarcoma.

Radiation therapy for chondrosarcoma typically involves multiple sessions of external beam radiation, which uses high-energy beams to target and kill cancer cells. Treatment is administered on an outpatient basis and may be given daily, 5 days a week, for several weeks. In some cases, a type of radiation therapy called radiosurgery may be used. This precise form of radiation therapy is often delivered in one longer session and may be repeated multiple times.

The type of radiation therapy used, the dosage, and the duration of treatment will depend on the specific case and your individual circumstances. In some cases of low-grade chondrosarcoma, radiation therapy may not be needed if the tumor has been fully removed during surgery.

If radiation therapy is recommended, it may be delivered externally using a special machine or internally using brachytherapy, which involves the placement of radioactive sources inside the body close to the tumor. A team of medical professionals, including a radiation oncologist (cancer specialist) and a neurosurgeon, will work together to determine the best treatment plan.

Proton beam radiation therapy is a type of external beam radiation therapy that uses beams of protons, rather than x-rays, to deliver radiation to the tumor. Protons can deliver more targeted radiation to the tumor and spare surrounding healthy tissue, reducing the risk of side effects. However, proton beam radiation therapy must be delivered at specialized centers that may not be available at your institution and thus travel must be coordinated.

Before beginning radiation therapy, patients usually feel more at ease if they know what to expect. Because treatment of a chondrosarcoma involves several specialists and a multistep process, it’s helpful to understand what happens before you begin treatment.

• Consultation: Before starting radiation therapy, you will have a consultation with a radiation oncologist who will evaluate your medical history, symptoms, and test results (for example, CT or MRI scans, neurological exams, and blood work).
• Simulation: A simulation may be performed to determine the exact location of the tumor and to plan the radiation treatment. During the simulation, you will lie on a treatment table, and a specialized machine will be used to create images of the tumor and surrounding structures.
• Treatment planning: Based on the results of the simulation, your medical team will create a customized treatment plan that considers the tumor size, location, and shape, as well as other factors such as surrounding tissues.
• Treatment: Radiation therapy is usually performed on an outpatient basis, without the need for general anesthesia or hospitalization. During the treatment, you will lie on a treatment table, and a specialized machine will be used to deliver the radiation to the tumor. The treatment is usually painless and takes only a few minutes.
• Follow-up: After completing radiation therapy, you will have regular follow-up appointments with your radiation oncologist and medical team to monitor your progress and check for any potential side effects.

Radiation therapy can be effective in treating chondrosarcoma, but it may also cause side effects. Some of the side effects may occur for a short period, whereas others may cause longer lasting problems. In the short term, possible side effects to expect include:

• Fatigue: Can be alleviated with rest, hydration, and a balanced diet
• Headaches: Common side effect that can be managed with medications, rest, and keeping hydrated
• Nausea and vomiting: More common in the early stages of treatment and can be treated with medication
• Hair loss in the treatment area: Usually a temporary side effect and hair often grows back after treatment
• Skin irritation: May include redness, itching, and blistering; can be minimized by using skin creams and avoiding irritants like hot water, harsh soaps, and tight clothing
• Swelling or inflammation in the treatment area: Anti-inflammatory medication and ice help manage this common side effect
• Cognitive problems: Memory loss, confusion, and difficulty concentrating can occur after treatment; specialized cognitive therapy, exercise, and medications can be helpful

As with any cancer treatment, radiation therapy has certain risks. It is important to discuss these with your medical team when deciding on the best treatment for chondrosarcoma. They can also provide information about how these adverse effects can be managed should they occur.

• Secondary malignancy: Radiation therapy can increase the risk of developing a new cancer, especially in the long term, because the radiation can damage the DNA of healthy cells. This risk is generally considered low but increases with the dose and duration of the radiation therapy.
• Damage to healthy tissue: Radiation therapy can damage healthy tissue in the treatment area, which can cause neurological symptoms such as weakness or numbness.

Although radiation therapy can slow or stop the growth of the tumor, there is a risk that the tumor may still recur after treatment.
As with short-term side effects, the risks associated with radiation therapy vary from person to person. Keep in mind that the benefits of the recommended treatment often outweigh the risks, but communicate with your medical team if you have any questions or concerns.

• Radiation therapy is often used with other treatments, like surgery, to manage chondrosarcoma.
• For patients who cannot undergo surgical removal of their chondrosarcoma, radiation therapy can be used as the primary treatment.
• Proton beam radiation therapy is the preferred radiation treatment because it delivers more targeted radiation to the tumor and spares surrounding healthy tissue, reducing the risk of side effects.
• Radiation therapy is usually performed on an outpatient basis.
• Side effects of radiation therapy include fatigue, headaches, nausea, hair loss, skin irritation, and swelling or inflammation.
• Radiation therapy carries certain risks, such as secondary malignancy, cognitive impairment, and tumor recurrence.
• The best treatment for chondrosarcoma depends on the tumor’s size, location, and grade. Work closely with your medical team to develop the ideal treatment plan for you.

• Sarcoma Foundation of America
• The Liddy Shriver Sarcoma Initiative
• Chondrosarcoma Foundation
• National Brain Tumor Society
• American Brain Tumor Association