Soft Tissue Sarcoma: Chemotherapy

Chemotherapy (chemo) uses medicines to kill cancer cells. The medicines are made to attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemo can also harm those cells. This can cause side effects.

Not everyone with a soft tissue sarcoma needs chemo. Whether or not you need chemo, and what type and dose of chemo you need, will depend mainly on these factors:

• The kind of soft tissue sarcoma you have

• The stage (extent) of the cancer

• The goal of treatment

• Your age and general health

• Concerns you have about side effects

• What treatments you have had in the past (if any)

Your healthcare provider may suggest chemo for any of these reasons:

• To try to shrink a tumor before surgery. This is called preoperative or neoadjuvant chemo.

• To try to kill any remaining cancer cells after surgery has been done. This is called adjuvant chemo.

• To treat sarcomas that have spread too far for surgery to be able to remove all of the tumor.

Before treatment starts, you will meet with a medical oncologist. This is a healthcare provider who specializes in treating cancer with medicines such as chemo. The medical oncologist will discuss your treatment options with you and explain what you might expect.

Depending on the chemo medicines you receive, you may get them in one of these ways:

• IV (intravenous). The medicine is given through a catheter that’s been put into a vein. The medicine may drip in slowly over several hours, or it may be given more quickly over a few minutes.

• Oral. You swallow these medicines as pills.

• Isolated limb perfusion (ILP). ILP is a type of regional limb therapy. For tumors on an arm or leg, sometimes the circulation to this limb is separated from the rest of the body (during minor surgery). The chemo is then put directly into an artery feeding the limb, allowing it to reach the tumor. The chemo is removed from the blood through a vein before it can reach the rest of the body. This process is repeated. This can allow your healthcare provider to give higher doses of chemo to the tumor. This is because it’s less likely to cause side effects in other parts of your body. This technique isn’t available at all treatment centers and should be performed only at centers with experience in regional limb therapy.

Chemo is normally given in an outpatient setting. That means that you get it at a hospital, clinic, or healthcare provider's office. Then you go home after your treatment. Less often, you may need to stay in the hospital during treatment. Your healthcare provider will watch you for reactions during your treatments. Since each chemo treatment may last for a while, you may want to take along something that’s comforting, such as music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.

You’ll receive chemo in cycles. This is done to reduce the damage to healthy cells and to give them a chance to recover. Each cycle consists of 1 or more days of treatment, followed by some time to rest. Cycles typically last 3 or 4 weeks. Your healthcare provider will discuss your schedule with you.

When chemotherapy is given with radiation therapy to help it work better, it is called chemoradiation.

There are numerous types of soft tissue sarcomas. Some chemo medicines are used only for specific types. These are some common chemo medicines used to treat soft tissue sarcomas:

• Ifosfamide

• Doxorubicin

• Dacarbazine

• Dactinomycin

• Cisplatin

• Cyclophosphamide

• Docetaxel

• Epirubicin

• Eribulin

• Gemcitabine

• Liposomal doxorubicin

• Methotrexate
• Paclitaxel

• Temozolomide

• Trabectedin

• Vinblastine

• Vincristine

• Vinorelbine

Three or more of these medicines are often combined as the first treatment. People who aren’t healthy enough to get three medicines may receive fewer medicines instead.

Side effects of chemo are different for everyone. They vary based on the medicines you receive. Below is a list of some of the most common side effects from chemo. Ask your healthcare provider what side effects to watch for.

• Hair loss. If you have hair loss, the hair will often grow back after the treatment stops.

• Nausea and vomiting. This side effect can often be controlled with medicines. Ask your healthcare provider about it.

• Mouth sores. Chemo can sometimes cause mouth sores. This might make it hard for you to eat or swallow. It's important to keep your mouth very clean and stay away from foods and substances that could irritate your mouth.

• Diarrhea. If you have diarrhea, take antidiarrheal medicines as prescribed by your healthcare provider. You may also need to make changes in your diet.

• Loss of appetite or changes in the way things taste. Talk to your healthcare provider if you find you’re having trouble eating or are losing weight. There are often ways to help.

• Increased risk of infection. During your chemo treatments, your white blood cell count may become low. This means your immune system won’t be working as well as it normally does to fight infection. It’s a good idea for you to stay away from people who have illnesses that you could catch. It’s also a good idea to take extra safety measures against cuts and scrapes that could become infected. Your healthcare provider will check your blood counts regularly during your treatment. Let your healthcare provider know if you have any signs of an infection. Symptoms include fever, sore throat, a new cough, or burning during urination.

• Bleeding and bruising more easily. Chemo can also lower your blood platelet counts. Platelets are needed to help the blood clot well and stop bleeding.

• Fatigue. You may feel tired while getting chemo. This normally goes away once treatment ends.

Most side effects get better over time when treatment is complete. Some other side effects can be long-term or permanent. For example, cisplatin, paclitaxel, and some other medicines can cause nerve damage (neuropathy). This can lead to pain, tingling, and numbness in your hands and feet. Doxorubicin can weaken the heart muscle. Your healthcare team will watch your heart function closely during treatment. Some other medicines can affect your ability to have children in the future. Ask your healthcare provider what long-term side effects you can expect and how to manage or prevent them.

It's important to know which medicines you're taking. Write down your medicines and ask your healthcare team how they work and what side effects they might have.

Talk with your healthcare providers about what signs to look for and when to call them. For example, some medicines can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings, weekends, and holidays?

It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.