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About chemotherapy

When, where and how you have chemotherapy for soft tissue sarcomas and the possible side effects.

How chemotherapy works

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 is called neoadjuvant chemotherapy.  It's not a common treatment for all types of 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 a Ewing's sarcoma and a type of rhabdomyosarcoma called embryonal rhabdomyosarcoma

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

Occasionally people have chemotherapy to shrink their sarcoma before surgery using a technique called isolated limb perfusion. This is a way of giving chemotherapy into just one arm or leg. It's complicated to do and is only available as a treatment for sarcoma at a couple of hospitals in the UK at the moment.

There's a risk of any cancer coming back 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.

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.

Overall, 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.

You might have chemotherapy to try to shrink the cancer that was left behind after the operation if your surgeon couldn't remove it all. But it is more usual to have radiotherapy in this situation.

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

You might have chemotherapy to try to shrink a cancer, control its growth, or relieve any symptoms it is causing if surgery isn't possible. You may have radiotherapy as well.

How you have chemotherapy

You usually have chemotherapy as a course of several cycles of treatment. Depending on the drug or combination of drugs, each treatment lasts from a few hours to a few days. Treatments for sarcoma can be given weekly or every 2, 3 or 4 weeks, depending on the drugs and your treatment plan.

You usually have this treatment into the bloodstream or by tablets.

Into your bloodstream

You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Taking your tablets or capsules

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Never stop taking a cancer drug without talking to your specialist first.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You’ll sit in a chair for a few hours so it’s a good idea to take newspapers, books or electronic devices to help to pass the time.

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

Before you start chemotherapy

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

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
Contact the doctor or nurse immediately if you have any signs of infection such as a temperature higher than 38C or generally feeling unwell. Infections can make you very unwell very quickly.

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 the few days that you’re having the chemotherapy drugs. The team caring for you can help to reduce your side effects.

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.

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. 

Dietary or herbal supplements and chemotherapy

Let your doctors know if you take any supplements or if you’re prescribed them by alternative or complementary therapy practitioners.

It’s uncertain how some nutritional or herbal supplements may 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.

Last reviewed: 
12 Feb 2015
  • Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    The ESMO / European Sarcoma Network Working Group, 2014

  • Adjuvant chemotherapy in soft tissue sarcoma (STS): A meta analysis of published data 
    JM O´Connor, M Chacón, FE Petracci and RD Chacón
    Journal of Clinical Oncology, 2008, 26: (May 20 suppl; abstr 10526)

  • Ifosfamide based combination chemotherapy in advanced soft tissue sarcoma: a practice guideline
    S Verma, J Younus, D Stys-Norman, AE Haynes and M Blackstein 
    Current Oncology, 2007: Aug;14(4):144–8

  • Dose intensive chemotherapy with growth factor or autologous bone marrow/stem cell transplant support in first line treatment of advanced or metastatic adult soft tissue sarcoma – A systematic review 
    S Verma, J Younus, D Stys-Norman, AE. Haynes and M Blackstein
    Cancer Care Ontario (CCO); 2006 Apr 11. 24 p. (Evidence-based series; no. 11-5)

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