About soft tissue sarcoma chemotherapy

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. Chemotherapy is usually given 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 can be given weekly or every 2, 3 or 4 weeks, depending on the drugs and your treatment plan.

There is information about some of the drugs used for sarcoma and their side effects on the next page in this section of CancerHelp UK. You have most chemotherapy drugs as injections into a vein, or through a drip. A few come as tablets or capsules. How you have your chemotherapy will depend on the particular drug or combination of chemotherapy drugs that your doctor prescribes.

Chemotherapy before surgery is called neoadjuvant chemotherapy. It is not commonly used for soft tissue sarcomas but can sometimes shrink a tumour before surgery to make it easier for your surgeon to completely remove it. If you have a sarcoma in a limb, it may 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). Generally radiotherapy, rather than chemotherapy, is used to shrink a tumour before surgery. But this depends on your individual situation. You may even have radiotherapy and chemotherapy combined. If you do, it may be as part of a clinical trial as 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 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 couple of hospitals in the UK at the moment.

With any cancer, there is a risk of it coming back even though it has been completely removed. Your doctor may suggest chemotherapy after surgery to try to reduce the risk of sarcoma coming back, but this is very rarely used. This type of treatment is called adjuvant therapy. The aim of the chemotherapy is to kill off any cancer cells that may have been left behind after your operation, but are too small to see.

A Cochrane review in 2000 found that chemotherapy with a drug called doxorubicin could lower the risk of sarcoma coming back after surgery. But 2 more recent large trials showed that adjuvant chemotherapy does not reduce the chance of the cancer coming back for most people with sarcoma. 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.

If your surgeon could not remove all of your sarcoma, you might have chemotherapy to try to shrink the cancer that was left behind after the operation. 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.

If you have a sarcoma that cannot be removed with surgery, you may have chemotherapy to try to shrink the cancer, control its growth, or relieve any symptoms it is causing. You may have radiotherapy as well.

The National Institute for Health and Clinical Excellence (NICE) have approved trabectedin (Yondelis) as a treatment for advanced soft tissue sarcoma. It is for people who have had treatment with other treatments such as anthracyclines (doxorubicin) and ifosfamide that did not work. Or people who can't have those treatments. Research suggests that trabectedin may extend life by at least three months more than other current NHS treatments. Under a scheme worked out between the NHS and the drug manufacturer, the NHS will pay for each patient's first five treatment cycles and the drug manufacturer will pay for any further treatment for as long as your doctor feels it is necessary. The Scottish Medicines Consortium (SMC) did not recommend trabectedin for use within the NHS, they say it is not cost effective. 

You may be asked 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. The EORTC 62012 trial is comparing doxorubicin on its own with the combination of doxorubicin and ifosfamide for many different types of soft tissue sarcoma. This trial is now closed and we are waiting for the results. Another trial is comparing a new chemotherapy drug called brostallicin with doxorubicin for advanced soft tissue sarcoma. These trials are listed on our clinical trials database. Choose 'sarcoma - soft tissue' from the dropdown menu of cancer types. There is a whole section about clinical trials in CancerHelp UK.

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed them by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section of CancerHelp UK.

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

For detailed information about chemotherapy look at the main chemotherapy section of CancerHelp UK. It explains the treatment including information about

• How it works
• How chemotherapy is planned and given
• General side effects
• Living with chemotherapy

If you would like more information about your particular chemotherapy, look at the information in our cancer drugs section, ask your chemotherapy nurse, or contact our cancer information nurses. They would be happy to help.