Soft Tissue Sarcoma: Treatment Introduction

Surgery is the main treatment for most soft tissue sarcomas. The goal of surgery is to remove the whole tumor or as much of it as possible. At the same time, the goal is to save as much of the affected body part as possible to maintain normal function. If the tumor is in an arm or leg, this is called limb-sparing surgery Imaging tests presurgery can be used to decide if your sarcoma can be removed safely and how much of the tumor can be removed. Tumors larger than a certain size will most likely also be treated with radiation therapy, chemotherapy, or both, either before or after surgery.

The goal of this treatment is to kill cancer cells using powerful beams of energy from radiation sources such as X-rays. It's also called external-beam radiation therapy (ERBT). The energy beams come from a large machine and are sent into the body and aimed at the tumor. There are several types of EBRT, including intensity-modulated radiation therapy, image-guided radiation therapy, stereotactic body radiation therapy and others. This treatment may be used to shrink a tumor before surgery. Or it may be used to kill cancer cells that are left after surgery.

Brachytherapy, or internal radiation, is another choice for some people. This form of radiation comes from tiny radioactive pellets that are put into or near the tumor. Soft tubes (catheters) are put in during surgery. The pellets are then put into these catheters to give the treatments. For high dose-rate brachytherapy, the radiation source and catheters are removed after treatment. Brachytherapy can be done alone or with EBRT.

Sometimes internal or external radiation is given during surgery. This way, a large dose can be sent right to the spot where the tumor was to kill any cancer cells that may be left behind. This is called intraoperative radiation therapy.

The goal of this treatment is to use medicines to destroy the cancer cells. In most cases, healthcare providers put the chemo medicines right into your blood through a vein. Your blood then carries the chemo throughout your body, killing cancer cells.

Less often, healthcare providers inject chemo right into the blood vessels around the tumor. This method isn’t yet standard treatment. Isolated limb perfusion (ILP) is another way chemo might be given if the sarcoma is only in an arm or leg. In this case, the circulation to the limb with the tumor is temporarily stopped using a tourniquet and the chemo is put into the blood in that limb. This allows the chemo to mostly affect the limb with the tumor. Not all healthcare providers agree on how to use this treatment or how well it works. Not all healthcare centers provide treatment with ILP. It should be done only at locations and by healthcare providers with experience.

You may get chemo before (neoadjuvant) or after surgery (adjuvant). In the case of metastatic disease (where cancer has spread into other parts of the body), chemo may be the only treatment used. Chemotherapy may be combined with radiation therapy. This is called chemoradiation.

This treatment uses medicines that attack certain parts of cancer cells. They can stop or slow down cancer cell growth. Targeted therapies focus on the cancer cells and do less damage to normal cells than chemo. They can help treat certain types of soft tissue sarcomas. This therapy can be used alone or with chemotherapy. This type of treatment may be used first for some types of soft tissue sarcomas. Tyrosine kinase inhibitor is a type of targeted therapy.

Your healthcare provider may suggest treatments that help ease your symptoms but don’t treat the cancer. These can sometimes be used with other treatments. Or your healthcare provider may suggest supportive care if they believe that treatments are likely to do you more harm than good.