About soft tissue sarcoma radiotherapy

Radiotherapy uses high energy X-rays to cure cancer. For soft tissue sarcoma, your doctor may suggest radiotherapy for any of the following reasons.

• After surgery, to try to stop the sarcoma coming back
• To shrink cancers before surgery
• To shrink secondary cancers
• To shrink and slow the growth of advanced sarcomas and relieve symptoms

Most people with soft tissue sarcoma have radiotherapy after surgery to remove the tumour. Trials have compared radiotherapy before surgery (neoadjuvant radiotherapy) to radiotherapy after a sarcoma has been removed (adjuvant radiotherapy). The trials found that radiotherapy before surgery causes more problems with wound healing than radiotherapy afterwards. In the UK, radiotherapy after surgery is the standard treatment. But radiotherapy before surgery treats a smaller area and so can be helpful if there are body structures near to the sarcoma that could be harmed if they were included in the treatment area. We also know that radiotherapy before surgery can sometimes shrink it so that it is easier to remove. This is known as down staging a sarcoma but it is not routinely used.

Radiotherapy is often used after surgery to kill off any sarcoma cells that may have been left behind. This is called adjuvant radiotherapy. There are usually only two situations where sarcomas are not treated with radiotherapy after surgery. These are

• Low grade tumours that have been completely removed
• High grade sarcomas that are smaller than 5cm, near the body surface (rather than deep in the tissues) that have been completely removed with a wide border of healthy tissue that contains no cancer cells

If you do need radiotherapy, you will usually have between 6 and 7 weeks of daily treatments. The treatment will not begin until your wound has completely healed. Radiotherapy given sooner would slow down the healing process.

At the moment, doctors give radiotherapy to quite a large area after surgery for sarcoma. The VORTEX trial is giving radiotherapy to a smaller area to see if this causes fewer side effects. This trial is listed on our clinical trials database. Choose 'sarcoma - soft tissue' from the dropdown list of cancer types.

Your doctors may suggest you have radiotherapy before surgery but this is not common. It is called neoadjuvant radiotherapy. Radiotherapy can shrink the sarcoma and make it easier to remove. You may then be able to have a smaller operation. Radiotherapy before surgery may also reduce the risk of the cancer coming back in the future by killing off any cells in the area that have broken away from the main tumour.

Some research into radiotherapy before surgery has shown it can increase the risk of wound complications after your operation, particularly for sarcomas in the leg. But it may be the best choice of treatment for sarcomas in some parts of the body. The dose of radiotherapy given before surgery is lower than when it is given after surgery. Do ask your specialists if you have any questions about why they have recommended a particular type of treatment for you.

If your cancer has spread or come back after it was first treated, it may not be possible to get rid of it completely. But it may be possible for your doctor to control the growth of the cancer for a while with radiotherapy and sometimes chemotherapy.

A growing cancer can cause symptoms by pressing on nerves and other body tissues. Radiotherapy can relieve these symptoms by shrinking the tumour and so relieving the pressure. This type of radiotherapy is called palliative treatment and you may just have a small number of treatments. You may have one treatment a day for a few days, or a several treatments with a few days break between each.

You have radiotherapy treatment in the hospital radiotherapy department. You are likely to have treatment once a day from Monday to Friday, with a rest at the weekends. If you are having radiotherapy for symptoms, you may only have a small number of treatments so that you do not have to keep coming back to the hospital. If you are having radiotherapy after surgery, you may have treatment each weekday for between 6 and 7 weeks.

Radiotherapy is carefully planned. At your first visit, you lie under a large machine called a simulator. This takes X-rays or a CT scan of the treatment area. The doctor uses the scans or X-rays to work out where to give the treatment. The aim is to kill all the cancer cells and miss as much healthy body tissue as possible.

You will have a pinprick tattoo made on your skin. The radiographer uses this to line up the radiotherapy machine each day when you have your treatment. You may have more marks made with felt pen. If so, you must be careful not to wash them off. They will fade during your course of treatment, but the radiographers will ink them back in again.

Each treatment only takes a few minutes. The radiographer will position you on the couch and make sure you are comfortable, which may take a few minutes. You will then be left alone for the minute or two the machine is switched on and you must lie very still. The staff will be able to hear you through an intercom, so you can call if you need them. The treatment does not hurt. You won't be able to feel it at all.

Having external radiotherapy does not make you radioactive. It is perfectly safe to be with other people, including children and pregnant women, throughout your treatment course.

Radiotherapy may cause the following effects.

• Tiredness
• Reddening of the skin
• Loss of hair

Tiredness can occur, especially toward the end of a course of treatment. The tiredness wears off over a few weeks once the treatment ends.

Reddening of the skin can happen. If you are having a lot of treatment, or if your skin is sensitive to the radiation, it may peel as well as going red. If it gets very sore, your specialist may stop the treatment for a short time so your skin can recover. Remember not to put any creams or lotions on your skin. If it is sore, tell your nurse, radiographer or doctor and they will give you something that is safe to use. Your doctor can prescribe painkillers for you if you need them.

Hair loss happens in the treatment area. You will only have hair loss from your head if you are having radiotherapy to your head. You may lose body hair in the treatment area - for example, leg hair if your leg is being treated. The hair may grow back but sometimes doesn't. If it does grow back, it can take up to a year and it may be patchy. Whether the hair grows back and how long it takes depends on the amount of treatment you have had.

Radiotherapy may cause specific side effects depending on which part of the body is treated. 

If you have radiotherapy to your abdomen or pelvis, you may feel sick or have diarrhoea. Or you may have some abdominal pain or bladder irritation.

Radiotherapy to the head and neck can cause a sore dry mouth. Other side effects from radiotherapy to the head and neck include thickened saliva, difficulty in swallowing, changes in taste, and feeling sick.

Women must tell their doctor or radiographer if they think they are, or could be pregnant, as radiotherapy can harm a developing baby.

You can find detailed information about the side effects of radiotherapy to different parts of the body in the main radiotherapy section of CancerHelp UK.

Radiotherapy treatment to a joint, such as a knee or elbow, can make it stiff by causing hardening of tissues (fibrosis) in the treatment area. It is important to keep using the joint as normally as you can. Regular exercise will help you to be able to keep moving the joint and stop it from stiffening up.

Months or years after radiotherapy, some people develop lymphoedema. Lymphoedema is swelling in the area close to where the radiotherapy was given. The radiotherapy damages the small tubes that circulate tissue fluid around the body (the lymphatic vessels). Fluid builds up behind the blockage and causes swelling in the tissues. Radiotherapy is planned to minimise the risk of lymphoedema developing. Doctors now try to prevent it by leaving a column of untreated tissue along your arm or leg. So, they don't treat your arm or leg all the way round. If you do get swelling in your hand or foot after radiotherapy to that limb, tell your specialist. Lymphoedema can't be cured. But there is treatment to control lymphoedema. The earlier it is diagnosed, the easier it is to control.

People who have treatment to the pelvic area or top of the thighs may become unable to have children (infertile) due to the effects of treatment on the testes, or ovaries and womb. This can be very upsetting. Men may be able to store sperm in a sperm bank before they have treatment.  And doctors will try not to include a woman's ovaries in the treatment field where possible. There is information about coping with infertility after treatment in the cancer and sexuality section of CancerHelp UK.

Look at the main radiotherapy section in CancerHelp UK. It tells you more about this type of treatment including

• What radiotherapy is
• How your radiotherapy treatment is planned
• Possible side effects