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Radiation therapy uses high-energy rays or particles to kill cancer cells. However, osteosarcoma cells are not easily killed by radiation. So, radiation is not typically used as a treatment plan in osteosarcoma. Surgical removal of all tumor tissue should always be attempted and is the only proven way to achieve local control. However, in selected cases, radiation can play an important role. For example, radiation is needed when the tumor is not resectable due to technical reasons and/or medical reasons. These reasons could be due to the site of osteosarcoma. Also, after surgery if there is still cancer within the tissue margins, meaning the tissue that surrounded the tumor, radiation will be needed.

The dosage depends on many factors and will be determined by your radiation oncologist. In general, recommended dosages are:

• 56-62 Gy in 2 Gy fractions where margins are microscopically involved, meaning if little cancerous tissue is left behind after surgery.
• 64-70 Gy where macroscopic tumor tissue is left behind, meaning if a larger amount of cancerous tissue is left behind after surgery.
• 70 or more Gy for inoperable osteosarcoma, meaning that they could never take out the tumor with surgery. due to technical or medical problems.

During radiation therapy, a beam is carefully positioned so that it kills as many of the osteosarcoma cells and as few of the good cells as possible. Other parts of your body not receiving the radiation may be protected with special metal sheets that do not allow the rays to enter.

Radiation therapy normally lasts only a few minutes and does not hurt. Radiation therapy is similar to having a regular x-ray taken. You will normally have one treatment a day for a period of 2-6 weeks.

Side effects of radiation

Because radiation may kill normal cells in addition to the osteosarcoma cells, side effect may occur. These may include:

• Tiredness, even after your treatments have finished.
• Redness or tenderness of the skin, like with a sunburn.
• Loss of hair in the area where you received the radiation.

Make sure to talk to your treatment team about steps you can take to cope with or lessen these side effects.