Treatment options for soft tissue sarcoma
A team of specialist doctors and other professionals discuss the best treatment and care for you. They are called a sarcoma multidisciplinary team (MDT).
The treatment you have depends on:
- the type of sarcoma
- where your sarcoma is
- how far it has grown or spread (the stage)
- how abnormal the cells look under a microscope (the grade)
- your general health and level of fitness
You should be treated at a specialist sarcoma centre. Your sarcoma specialist will talk to you about:
- your treatment
- its benefits
- the possible side effects
Treatment overview
Surgery is the main treatment for soft tissue sarcoma. Surgeons aim to remove as much of the cancer as possible.
Stage 1, 2 or 3 sarcoma might be completely removed with surgery. In some situations, surgery may also be used to remove sarcoma that has spread to other parts of the body (stage 4).
Limb sparing surgery
Removing the cancer but not the affected limb is called limb sparing surgery. It is also called limb salvage surgery.
Surgery to remove a limb (amputation)
Very rarely, your surgeon might need to remove all or part of your limb.
Radiotherapy uses high energy rays to kill cancer cells. It is often used with other treatments for soft tissue sarcoma.
Before surgery (neoadjuvant radiotherapy)
The aim of radiotherapy is to kill the cancer cells around the tumour. It may shrink the cancer. This will make it easier to remove with surgery and stop the cancer from coming back. It might mean you have just the cancer and an area of healthy tissue around it (margin) removed. This is called limb sparing surgery.
After surgery (adjuvant radiotherapy)
Radiotherapy after limb sparing surgery aims to kill any cancer cells which may have been left behind after surgery. It also helps to stop the cancer from coming back.
You usually begin your treatment some weeks after surgery. This allows time for the area to heal before radiotherapy.
On its own
Sometimes radiotherapy is used on its own. This is when the position of the cancer makes surgery to remove it too difficult. In this situation, radiotherapy aims to control the sarcoma and slow its growth.
Doctors also use radiotherapy to:
- control a sarcoma that has already spread or come back after other treatments
- relieve symptoms
Proton beam therapy
You might have a type of radiotherapy called proton beam therapy for sarcoma in the spine or close to the spine. This type of radiotherapy uses high energy or low energy proton beams to treat cancer.
Proton beam uses a very targeted approach. This way it saves surrounding tissue from getting a dose of the radiotherapy.
Chemotherapy means using anti cancer drugs to destroy cancer cells.
It is not yet clear how helpful chemotherapy is for some types of soft tissue sarcoma. So you may be asked to join a clinical trial if you are offered chemotherapy.
Chemotherapy is not a standard treatment after surgery. This is because some research shows that it does not help reduce the risk of sarcoma coming back (recurring). This is for most types of sarcoma.
Your specialist will discuss this with you. They are most likely to suggest chemotherapy for people with
- large sarcomas
- high grade sarcomas
- sarcomas that are at most risk of cancer coming back
Some people might have chemotherapy before surgery. This is called neoadjuvant chemotherapy. It aims to shrink the cancer. and make it easier to remove with surgery. This is not standard treatment.
Doctors sometimes use a specialist technique called isolated limb perfusion. This means giving chemotherapy to the affected arm or leg. It is a very complicated technique. It is only available at a few specialist hospitals.
For some types of sarcoma chemotherapy can be used to treat symptoms. Or it is used to control sarcoma that has spread or come back after other treatments.
Targeted cancer drugs work by ‘targeting’ those differences that help a cancer cell to survive and grow.
People with gastrointestinal stromal tumours (GISTs) that have spread might have a drug called imatinib (Glivec). Imatinib can work very well at controlling the growth of GISTs for several years or more.
Treatment by stage
Small localised sarcoma
Surgery is the main treatment and it might cure you. Your surgeon aims to remove the cancer and a border of healthy tissue around it. Having a border of healthy tissue (with no cancer cells) lowers the risk of sarcoma coming back (recurring).
You might have radiotherapy after surgery. The aim of this is to kill any cancer cells which may have been left behind if the surgeon is unable to remove enough healthy tissue around the cancer. This may happen because the tumour is close to an important structure such as a nerve, blood vessel or bone. Radiotherapy help to stop the cancer from coming back.
Large sarcoma that has not spread
You may have radiotherapy before surgery, mostly for large, deep and high grade sarcomas. You may also have radiotherapy and chemotherapy before surgery. This is only done with particular types of sarcoma such as rhabdomyosarcoma and Ewing sarcoma. Some types of sarcoma do not respond so well and are less likely to shrink. You may also have radiotherapy after surgery to kill off any cancer cells that may have been left behind.
Sarcoma that has spread
Radiotherapy or chemotherapy (or a combination of both) aims to help keep the cancer under control for longer and to relieve symptoms.
Specialist surgery might be possible for sarcoma that has spread to the lungs or liver, or other parts of the body. This is not suitable for everyone. Your specialist will discuss it with you if it is an option in your situation.
People with a type of sarcoma called a gastrointestinal stromal tumour (GIST) may have the targeted drug imatinib (Glivec). If that stops working, your doctor may recommend another targeted drug called sunitinib (Sutent). A third drug called Regorafenib (Stivarga) is an option for people in whom sunitinib stops working.
Clinical trials
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.
