Soft Tissue Sarcoma: Treatment Introduction

Learning about your treatment choices

You may have questions and concerns about your treatment choices. You may want to know how you’ll feel and function after treatment. You may also want to know if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. They can tell you what your treatment choices are, how well they’re expected to work, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or they may offer more than one and ask you to decide which you’d like to use. It can be hard to make this decision. It’s important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your choices. You may want to get another opinion before deciding on your treatment plan. You may also want to involve your family and friends in this process.

Understanding the goals of treatment for soft tissue sarcoma

For many soft tissue sarcomas, the goal of treatment is to cure the cancer. If a cure isn’t possible, treatment may be used to shrink the cancer or keep it under control. Treatment can also improve your quality of life by helping to control the symptoms of the disease. The goals of treatment can include one or more of these things:

• Remove or destroy the main tumor

• Remove or destroy tumors in other parts of the body

• Stop or slow the growth or spread of cancer cells

• Prevent or delay the cancer's return

• Ease symptoms from the cancer, such as pain or pressure on nearby organs

Types of treatment for soft tissue sarcoma

Many kinds of treatment can be used for soft tissue sarcoma. Many times, different combinations of treatment may be used. In most cases, the size of the tumor and whether it’s invaded nearby structures determines what type of treatment you’ll have. Each treatment has its own goals.

Surgery

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.

Radiation therapy

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.

Ablation therapy

Ablation is a type of local treatment that uses extreme heat or extreme cold to kill cancer cells. This is also called thermal ablation. It may be used to destroy small tumors. The two types of thermal ablation are: Cryotherapy, which uses very cold substance to freeze tissue, and radiofrequency ablation, which uses high-energy radio waves to heat cancer cells.

Chemotherapy (chemo)

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.

Targeted therapy

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.

Immunotherapy

This systemic treatment uses the body's own immune system to improve its ability to find cancer cells and kill them. The monoclonal antibodies, pembrolizumab and nivolumab, are types of immunotherapy. These may be combined with targeted therapy for specific sarcomas.

Supportive care

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.

Clinical trials for new treatments

Researchers are always looking for new ways to treat soft tissue sarcoma. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.

Talking with your healthcare provider

At first, thinking about treatment choices may seem overwhelming. Talk with your healthcare providers, nurses, and loved ones. Make a list of questions. Consider the benefits and side effects of each choice. Talk about your concerns with your healthcare provider before making a decision.