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Types of treatment for soft tissue sarcoma

Men and woman discussing soft tissue sarcomas

This page gives you an overview of the treatment for soft tissue sarcomas. There is information about

 

A quick guide to what's on this page

Types of treatment for soft tissue sarcoma

Surgery is the main treatment for most types of soft tissue sarcoma. You may also have other treatments such as radiotherapy, chemotherapy or biological therapy. The treatment depends on the type of sarcoma you have, how far your cancer has grown or spread (the stage), your general health and fitness, and your age.

Treatment by stage

For small, localised sarcomas, surgery is the main treatment and may cure you. If your surgeon cannot completely remove the sarcoma with a wide border of healthy tissue around it, you are likely to have radiotherapy afterwards. This is to help stop the cancer coming back.

If you have a larger tumour that has not spread, you may have chemotherapy, or possibly radiotherapy, before surgery. This is designed to shrink the sarcoma so that you won't need as big an operation. This is only done with particular types of sarcoma such as rhabdomyosarcoma or Ewings sarcoma. Some types do not respond so well and are less likely to shrink. You may also have radiotherapy after surgery. 

If your sarcoma has spread, for example to the lungs or liver, you may still have surgery to remove the areas of sarcoma. This can help to relieve symptoms and control the cancer for longer. Instead of surgery your doctor may use other ways of destroying the sarcoma cells in the liver or lung, such as radiowave treatment or freezing the tumours (cryotherapy). You may also have chemotherapy, radiotherapy or any combination of these three types of treatment. Some types of sarcoma can be controlled for a time by biological therapies.

Your doctor will discuss your treatment options with you.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating soft tissue sarcoma section.

 

 

The main treatments

For small, localised sarcomas, surgery is the main treatment and may cure you. You are likely to have radiotherapy afterwards if your surgeon could not completely remove the sarcoma with a wide border of healthy tissue containing no cancer cells. The radiotherapy helps to stop the cancer coming back.

If you have a larger tumour that has not spread, you may have radiotherapy or chemotherapy before surgery. This treatment is designed to shrink the sarcoma so that you won't need so much surgery. This is only done with particular types of sarcoma such as rhabdomyosarcoma and Ewings 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. 

If your sarcoma has spread, for example to the lungs or liver, you may have surgery to remove the areas of spread. This can help to relieve symptoms and keep the cancer under control for longer. You may also have chemotherapy, radiotherapy or any combination of these 3 types of treatment. People with a type of sarcoma called gastro intestinal stromal tumour (GIST) may have the biological therapy drug imatinib (Glivec). If that stops working your doctor may recommend another biological therapy drug called sunitinib (Sutent).

 

Surgery

An operation to remove the tumour is the main treatment for most soft tissue sarcomas. The aim of the surgery is to remove as much of the cancer as possible. As well as removing the cancer, the surgeon will remove a good border of surrounding healthy tissue. This is to try to make absolutely sure that they take away the whole sarcoma. The border is usually a few millimetres and is called a healthy margin or clear margin. This means the cancer is less likely to come back in that area. At the same time, the surgeon tries to take away as little healthy tissue as possible, so that the impact of the surgery is as small as possible.

In the past, surgery for sarcomas in the arm or leg often meant removing the affected limb completely (amputation). But there have been big improvements in surgical techniques, such as being able to re-attach tiny blood vessels (microvascular surgery). Or sometimes surgeons repair the operation site with muscle from other parts of the body (a muscle flap) and skin grafts. These improvements mean that amputation can now be avoided in most people and you may have limb sparing surgery instead. Fewer than 1 in 20 people diagnosed with sarcoma need amputation these days. Unfortunately, the size and position of a soft tissue sarcoma in the arm or leg may still mean that amputation is needed in some people.

Surgery is used to remove stage 1, 2 and 3 sarcomas. If surgery to remove a sarcoma is too difficult because of its position in the body, you may have radiotherapy instead of surgery. In some areas of the body, radiotherapy may also be difficult because of the risk of damage to vital organs.

Many people have radiotherapy after surgery to try to kill off any remaining sarcoma cells and reduce the risk of the sarcoma coming back. Whether you need radiotherapy or not depends to some extent on the grade, size and site of your sarcoma. Radiotherapy may not be necessary after surgery if you have

  • A low grade sarcoma
  • A very small sarcoma
  • A sarcoma that is near the body surface (superficial) and not buried deep in the tissues

We have information about surgery for soft tissue sarcomas.

In some situations, surgery may also be used to remove sarcoma that has spread to other parts of the body (stage 4). This is most often done when the sarcoma has spread to the lungs or liver. There are also specialist surgical techniques to destroy sarcoma that has spread to the lung or liver. You can read about these in our section about surgery for sarcoma that has spread.

 

Radiotherapy

Radiotherapy uses high energy rays to kill cancer cells. You may have radiotherapy before or after surgery for sarcoma, or on its own as your main treatment.

Treatment before surgery is called neo adjuvant treatment. The aim is to shrink the tumour so that it is easier to remove. If the treatment is successful, you may be able to have a smaller operation than you otherwise would have. Doctors call this down staging the sarcoma.

Doctors use radiotherapy for sarcoma after surgery, to kill off any cancer cells that may have been left behind. They call this adjuvant radiotherapy. If you do have radiotherapy after surgery, you usually begin your treatment between 6 and 12 weeks after your operation. This gives the area time to heal before the radiotherapy starts. Radiotherapy treatment may last for up to 7 weeks. The exact time will depend on the type, size and position of the sarcoma.

Sometimes, radiotherapy may be the main treatment for sarcoma – for example with Ewings tumours, you have radiotherapy to try to cure the sarcoma. But otherwise radiotherapy is usually used when the position of the cancer makes surgery to remove it too difficult. In this situation, radiotherapy is used to try to control the sarcoma and slow its growth.

Doctors also use radiotherapy to treat symptoms or try to control a sarcoma that has already spread or has come back since it was first treated.

You can read more in our section about radiotherapy for soft tissue sarcoma.

 

Chemotherapy

Chemotherapy means having anti cancer drugs. For sarcoma, chemotherapy is mostly used to treat

  • Ewing's sarcomas
  • Embryonal or alveolar rhabdomyosarcoma
  • Children or young adults with sarcoma
  • Sarcomas that have spread

It is not yet clear how helpful chemotherapy is in other situations. So you may be asked to join a clinical trial if you are offered chemotherapy. Some studies have shown that chemotherapy does not help to reduce the chance of most types of sarcoma coming back after surgery. So chemotherapy is not standard treatment after surgery. Your specialist will discuss this with you individually. They are most likely to suggest chemotherapy for people with large, high grade sarcomas, who are most at risk of the cancer coming back.

The chemotherapy drugs that you usually have for soft tissue sarcomas are injected into a vein or given through a drip. You may have a single chemotherapy drug or a combination of two or more drugs. You can find out more in our section about chemotherapy for soft tissue sarcomas.

Chemotherapy for soft tissue sarcoma can sometimes be given before surgery to try to shrink the cancer. This may make it easier to remove but is not standard treatment. This is called neoadjuvant chemotherapy. 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 is complicated to do and is only available as a treatment for sarcoma at a few hospitals in the UK at the moment.

Chemotherapy can be used to treat symptoms or try to slow down a cancer that has already spread or has come back since it was first treated. Doctors call this palliative chemotherapy. Research is continuing to try to improve the success of this type of treatment. Trials for soft tissue sarcoma are listed on our clinical trials database.

 

Biological therapy

Biological therapy drugs work by stopping a series of chemical reactions that make the cancer cells grow and divide. People with gastrointestinal stromal tumours (GISTs) that have spread may have a biological therapy drug called imatinib (Glivec). Studies have shown that imatinib can work very well at controlling the growth of GISTs for several years or more. 

You can find detailed information on our page about biological therapy for soft tissue sarcoma.

 

Deciding on treatment

Your doctors will plan your treatment taking into account

  • The type of sarcoma you have
  • How far your cancer has grown or spread (the stage)
  • Your general health and fitness
  • Your age

Cancer treatments can be divided into local and systemic treatments. Surgery and radiotherapy are local treatments. They treat just one area of the body. 

Systemic treatments are carried in the bloodstream and can reach cancer cells wherever they are in the body, not just at the original tumour site. Chemotherapy and biological therapies are systemic treatments.

Children's impact statement - Soft tissue sarcoma

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Updated: 11 February 2015