Chemotherapy for soft tissue sarcoma

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body.

When you might have chemotherapy

Chemotherapy before surgery

Chemotherapy before surgery is called neoadjuvant chemotherapy.  It's not a common treatment for soft tissue sarcomas. But you might have it to shrink a tumour before surgery to make it easier for your surgeon to completely remove it.

For sarcomas in a limb, it might mean that you can have just the tumour removed (limb sparing surgery). Rather than having the whole limb or part of it removed (an amputation). 

You usually have chemotherapy before surgery if you have:

• soft tissue Ewing sarcoma 
• a type of rhabdomyosarcoma called embryonal rhabdomyosarcoma

For some types of soft tissue sarcoma, radiotherapy may be better at shrinking the tumour before surgery. Doctors are also looking into combining radiotherapy and chemotherapy before surgery. But this is not yet a standard treatment.

Occasionally people have chemotherapy using a technique called isolated limb perfusion (ILP). This is a way of giving chemotherapy into just one arm or leg. You might have it:

• before surgery to shrink sarcomas
• after radiotherapy, if further radiotherapy is not possible
• as part of palliative care for sarcomas that can’t be removed with surgery

ILP is complicated to do and is only available as a treatment in a few hospitals in the UK.

Chemotherapy after surgery

Your doctor might suggest chemotherapy after surgery if you have a high risk of the sarcoma coming back. This aims to reduce the risk and is called adjuvant therapy. The aim is to kill off any cancer cells that might have been left behind after your operation but are too small to see.

You might also have it after surgery if your sarcoma is more sensitive to chemotherapy. This means the cancer cells are more likely to be killed by chemotherapy.

A chemotherapy drug called doxorubicin could lower the risk of sarcoma coming back for some people after surgery. Combining doxorubicin with ifosfamide can lower the risk further but has more side effects.

Research in this area suggests that adjuvant chemotherapy is only likely to help people with the highest risk of their sarcoma coming back. Research is continuing to try to improve the results of chemotherapy treatment for sarcoma.

If your sarcoma was not completely removed

Sometimes, a surgeon is not able to remove all of the cancer. In this situation you might have radiotherapy to shrink the cancer that is left behind. Some people have chemotherapy (instead of radiotherapy) to shrink the cancer.

The aim of treatment is to try and slow down the growth of the cancer. Unfortunately, even if the chemotherapy shrinks it completely, there is a risk of the cancer coming back at some time in the future.

Chemotherapy to relieve symptoms

If surgery is not possible, you might have chemotherapy to

• try to shrink a cancer
• control its growth
• relieve any symptoms

You may have radiotherapy as well as chemotherapy.

Clinical trials for chemotherapy

Your doctor or nurse may ask you to take part in a clinical trial to test new chemotherapy drugs. This is because it is important for doctors to find out which treatments work best. They aim to get the best results with the fewest side effects. 

Types of chemotherapy

There are a number of chemotherapy drugs used to treat soft tissues sarcoma. You usually have a combination of 2 or 3 drugs together, but you might just have one.

The type of drugs you have depends on different factors. These factors include your risk of the cancer coming back. And whether you have other medical conditions, such as heart problems.

Examples of chemotherapy for soft tissue sarcoma include:

• Doxorubicin
• Ifosfamide (Mitoxana)
• Vincristine
• Gemcitabine (Gemzar)
• Docetaxel (Taxotere)
• Trabectedin (Yondelis)
• Paclitaxel
• Eribulin (Halaven)
• Dacarbazine

Check what the name of your regimen is with your doctor or nurse, then take a look at our A to Z list of cancer drugs.

How you have chemotherapy

You usually have treatment into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line you might have treatment through a thin short tube (a cannula). The cannula goes into a vein in your arm each time you have treatment.

You might have some drugs as capsules.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test. 

Side effects

Common chemotherapy side effects include:

• feeling sick

• loss of appetite

• losing weight

• feeling very tired

• increased risk of getting an infection

• bleeding and bruising easily

• diarrhoea or constipation

• hair loss

Side effects depend on:

• which drugs you have

• how much of each drug you have

• how you react

Tell your treatment team about any side effects that you have.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

When you go home

Chemotherapy for soft tissue sarcomas can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you:

• take any supplements
• have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.

Some studies seem to suggest that fish oil preparations may make chemotherapy drugs work less well. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.