Bone Cancer Treatment in Germany

Primary bone tumors are rare, so bone cancer treatment in Germany is concentrated at university hospitals and centers that specialize in sarcomas. The German Cancer Society certifies such centers: they must operate on sarcomas regularly, have their own pathology and radiation therapy departments and discuss every patient at a tumor board.

Children and young adults with osteosarcoma and Ewing sarcoma have long been treated in Germany under cooperative protocols shared by many clinics in the country and in Europe. This means that the chemotherapy regimen and the timing of surgery and radiation are set out in advance and have been tested on a large number of patients. More about Ewing sarcoma on the page Ewing sarcoma treatment.

Bone cancer diagnosis in Germany begins with verifying the diagnosis. German doctors study the images on the disc and almost always ask for the biopsy slides and blocks: they are reviewed by a reference pathologist who specializes in bone and soft tissue tumors. If necessary, molecular tests are performed to help distinguish one sarcoma from another.

To assess the spread of the disease, an MRI of the whole affected bone, a lung CT and PET-CT or a bone scan are usually needed. If no biopsy has been done yet, it is performed at the center where the surgery will take place, so that the needle path does not interfere with the future operation.

Bone cancer treatment methods in Germany are chosen by a multidisciplinary tumor board.

Surgery. This is the main method for most bone sarcomas. The tumor is removed in one piece with a margin of healthy tissue, and the defect is filled with a modular endoprosthesis, a bone graft or a combination of both. For children, expandable prostheses that are lengthened as the child grows are used. Complex operations on the pelvis, sacrum and spine are performed at centers with extensive experience of such procedures.

Chemotherapy. In osteosarcoma and Ewing sarcoma, it is given before and after surgery according to the protocol. The proportion of tumor cells that have died after the first cycles helps assess the prognosis and adjust further treatment.

Radiation and proton therapy. Radiation is important in Ewing sarcoma and in tumors that cannot be removed completely. For tumors of the skull base, spine and pelvis, and in children, proton therapy is often chosen: the proton beam stops in the tumor and affects nearby organs less. In Germany, this treatment is offered, for example, at the West German Proton Therapy Centre Essen.

Patients often ask about immunotherapy – treatment that helps the body’s own immune system recognize the tumor. It has become standard in lung cancer and melanoma, but in bone sarcomas its effectiveness is still limited. When it comes to immunotherapy for bone cancer Germany follows the same approach as other leading countries: checkpoint inhibitors and other immunological methods are used mainly for relapse, for certain tumor types or within clinical trials.

If you are offered immunotherapy, it is important to understand what the decision is based on: whether the tumor has features that predict a response and which standard treatment options have not yet been used. Each case is discussed individually, and we pass these questions on to the oncologists of the German clinic together with your records.

Patients with bone sarcomas are accepted by university hospitals and large cancer centers, such as Charité in Berlin and the university hospitals of Essen, Cologne, Tübingen, Düsseldorf and Leipzig. Proton therapy is provided at specialized centers such as the West German Proton Therapy Centre Essen.

The choice depends on the type of tumor and its location: for surgery on the pelvis or spine, the experience of a particular team matters, and for a child, a pediatric oncology department. The coordinator clarifies this with each clinic before sending you a program.

The cost of bone cancer treatment in Germany is made up of the review of the diagnosis, surgery with reconstruction, chemotherapy cycles and radiation. Proton therapy and complex operations on the pelvis or spine noticeably increase the budget, so German clinics do not give general figures without reviewing the records.

Once the doctors have studied the scans and the biopsy, we request programs from several clinics and show you what they include. If you are comparing countries, there are pages on bone cancer treatment in Israel and on chondrosarcoma treatment in Germany.

To start bone cancer treatment in Germany, submit a request and send your scans, biopsy report and discharge summaries. The coordinator will pass them on to oncologists, and you will receive the doctors’ opinion and clinic programs. Ask the coordinator whether you can talk to a patient who has already completed treatment.