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About 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.

When you might have chemotherapy

Chemotherapy before surgery is called neoadjuvant chemotherapy.  It's not a common treatment for 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 sarcoma, 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 in a couple of hospitals in the UK at the moment.

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.

Sometimes, a surgeon is not able to remove all of the cancer. In this situation you might have radiotherapy to shrink the cancer that is left behind. Some people have chemotherapy (instead of radiotherapy) to shrink the cancer.

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

If surgery is not possible, you might have chemotherapy to

  • try to shrink a cancer
  • control its growth
  • relieve any symptoms

You may have radiotherapy as well as chemotherapy.

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 or hand. 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.

Talk to your specialist or advice line before you stop taking a cancer drug.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might 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 can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that 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
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have any signs of infection such as a temperature higher than 37.5C 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 a few days or so. Your treatment team can help to manage any side effects that you have.

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 have been prescribed anything by alternative or complementary therapy practitioners.

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. They 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: 
05 Apr 2018
  • UK guidelines for the management of soft tissue sarcomas
    A Dangoor and others
    Clinical Sarcoma Research, 2016. Volume 6, number 20 

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

  • EJC’s biennial report on metastatic soft tissue sarcoma: State of the art and future perspectives

    M Vos and others 

    European Journal of Cancer, 2018. Volume 88, pages 87-91

  • Identification of microRNA biomarkers for response of advanced soft tissue sarcomas to eribulin: Translational results of the EORTC 62052 trial

    E Wiemer and others 

    European Journal of Cancer, 2017. Volume 75, pages 33-40

  • High-risk soft tissue sarcomas treated with perioperative chemotherapy: Improving prognostic classification in a randomised clinical trial

    S Pasquali and others 

    European Journal of Cancer, 2018. Volume 93, pages 28-36

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