Musculoskeletal Cancers / Sarcoma - Treatment

Physicians from across Southern California send their musculoskeletal cancer patients to City of Hope because our musculoskeletal tumor specialists routinely treat children and adults with rare tumors.  Our treatment approach for these cancers combines chemotherapy and other drugs with surgery and radiation. Surgical oncologists, medical oncologists and radiation oncologists work together with pathologists, radiologists, rehabilitation experts and others to achieve the best possible outcomes for patients. In 85 percent of bone cancer cases, we are able to save the patient’s limb.

Because these types of tumors can grow rapidly, patients with a suspected musculoskeletal tumor should go directly to a sarcoma center of excellence.  At City of Hope, an initial assessment is made involving the expertise of dedicated radiologists, pathologists, interventional radiologists, surgeons and oncologists to obtain a precise diagnosis. 


In these types of cancers, surgery is typically required to remove the tumor and surrounding tissue, often including lymph nodes. Each case must be evaluated carefully to ensure that the most effective surgery is chosen for the individual. Musculoskeletal tumors usually affect the limbs. In the past, amputation was often required to prevent the disease from spreading to healthy tissue. Today, advanced surgical techniques combined with radiation therapy make it increasingly possible to preserve the limb. Limb-stabilizing devices may also be used to reduce the number of surgical procedures needed and accelerate the patient’s recovery.
Expandable Prosthetic Implants
City of Hope is a national center for the use of expandable prosthetic implants for limb-sparing reconstruction in children and adolescents.  These expandable prostheses are able to “grow” through noninvasive or minimally invasive techniques.  This allows us to accommodate for a child’s continued growth in future years without multiple significant surgeries. Using these devices, we are able to reduce the number of surgeries and improve the recovery time for children, while removing their bone cancer and reconstructing their limbs. 


Radiation therapy uses energy beams to destroy cancer cells. Radiation is used as an added measure after surgery to destroy any remaining cancer cells. However, radiation can be used before surgery, or it may be the main treatment in some cases. Radiation therapy can also be used to relieve symptoms when a cancer has spread. Types of radiation therapy used to treat musculoskeletal tumors include:

Helical TomoTherapy

TomoTherapy is an advanced radiation therapy system that merges intensity modulated radiation therapy with precision spiral computed tomography scanning. This allows doctors to deliver the highest dose of radiation in a way that matches the exact shape of the tumor, providing effective treatment while reducing exposure of healthy tissues.

In this procedure, tiny pellets of radioactive material smaller than a grain of rice are inserted directly into the cancerous tissue. The radiation attacks the tumor from the inside out. By directly targeting cancer, brachytherapy minimizes radiation to healthy tissue.


Chemotherapy, anticancer medicines given intravenously or by mouth, includes a wide range of drugs and treatment strategies to treat musculoskeletal tumors/sarcoma. Depending on the type and stage of disease, chemotherapy is given as the main treatment followed by surgery and/or radiation.


The Developmental Cancer Therapeutics Program focuses on the molecular basis of cancer to develop novel agents that fight cancer more effectively and with fewer side effects. Over the long term, scientists in the program aim to match individual patients with the highly customized therapies for the best clinical outcomes.

Psychosocial support is an important component of treatment for musculoskeletal tumors/sarcoma. At City of Hope, the treatment team includes psychologists, psychiatrists, social workers and childlife specialists to help patients and their families learn about their disease and treatment, cope with having a life-threatening illness, and support each other through the illness. 

Our team includes professionals in occupational therapy, physical therapy, recreational therapy, and speech and language pathology. Orthotics and prosthetic services are also are provided.

Occupational therapy
Occupational therapy focuses on restoring skills, teaching adaptive techniques and recommending adaptive equipment necessary in self-care, daily living, homemaking and work-related activities.

Physical therapy
Physical therapy facilitates patient recovery with a focus on mobility, exercise training, reconditioning and other specific therapies. Patients who experience the loss or function of a limb may require braces and prostheses. The City of Hope team includes orthotists and prosthetists who can design appliances that offer maximum function and comfort, and provide training in their use.

Recreation therapy
Recreation therapy promotes wellness and improves the quality of life through leisure activities. Our recreation therapists work to minimize the impact of disease and treatment in the lives of their patients.