Sarcoma

Sarcoma Treatments

An image of a person getting treatment in a machine with green and red lights on their body.

Sarcoma is a rare and complex cancer that often requires a team of experts in surgery, medical oncology, radiation, orthopedic oncology, neurosurgery, and reconstructive plastic surgery. At Columbia, these experts work together to bring you the best treatments available, all in one place.

Columbia’s sarcoma specialists use the most advanced treatments to achieve the best outcomes. Surgeons remove cancer while protecting as much healthy tissue as possible. Medical oncologists lead research on new treatments like immunotherapy and targeted therapy, and radiation experts use precise technology to destroy cancer cells while protecting nearby tissue and helping patients avoid limb removal. This combined expertise means excellent outcomes for our patients.

Your care team will talk with you about your options and help you choose the approach that’s right for you. Your treatment may include one or more of the following:

Surgery

Surgery is commonly used to treat soft tissue sarcomas. The goal of surgery for sarcoma is to remove as much of the tumor as possible, along with some of the tissue around it, so it does not return. Additional surgical approaches will depend on the location of the tumor:

  • For sarcomas of the arms and legs, removing the tumor sometimes means amputating the limb, though surgeons always look for ways to avoid this.  
  • For sarcomas of the uterus, a total hysterectomy (removal of the uterus and cervix) is usually performed. 
  • For pelvic tumors, surgeons may perform minimally invasive procedures using robotic surgery to preserve mobility while taking out soft tissue and bone. 
  • For sarcoma in the retroperitoneum, surgeries usually involved the colon, kidneys, spleen, or pancreas. 

Some types of sarcomas may require chemotherapy and/or radiation to shrink the size of the tumor before operating.

What Is Surgical Oncology?

Limb-sparing surgery

The goal of limb-sparing surgery is to preserve as much of the muscles, ligaments, and nerves as possible, without having to amputate the entire limb. Roughly 90% of sarcoma patients are candidates for limb-sparing surgeries. Orthopedic surgeons, neurologists, oncology surgeons, and reconstructive surgeons may collaborate on these intricate and innovative procedures.

Reconstructive surgery

After tumor removal, reconstruction can help restore your strength, movement, and appearance. Options include:

Allografts 

Some bone repairs can be accomplished using freeze-dried cadaver bones. This material can fill or replace segments removed during surgery, acting as scaffolding while your own bones heal and grow. Because allografts are associated with a higher risk of infection and can break down over time, surgeons are developing a new technique that provides the mid-bones with critical blood supply.  

Metal prosthesis 

A prosthesis is an artificial body part. A metal rod is used more frequently than cadaver bones in children affected by sarcoma. The reason for this is that additional sections can be added to the rod as the child’s body grows. Since the metal devices may begin to loosen over time, surgeons are now combining allografts with metal insert for better outcomes.  

Expandable prosthesis 

New expandable devices have been designed that mimic the growth of a child’s own healthy limbs. During clinic visits, these devices are expanded using an external magnetic field, sparing the child additional surgeries.  

Fibular autografts 

In this technique, a small segment of the patient’s own fibula is used to repair or replace an arm or leg bone that has been affected by sarcoma. Since the patient’s own fibula is harvested, the chances of infection and rejection are lower.

Chemotherapy

Chemotherapy can be given: 

  • Before surgery (neoadjuvant) to shrink the tumor and increase the chance of complete removal 
  • After surgery (adjuvant) to lower the risk of recurrence 
  • For advanced disease to control growth and relieve symptoms 

Chemotherapy uses medications (chemicals) to stop cancer growth and spread and to prevent cancer from recurring by causing rapidly dividing cancer cells to become damaged and die. Chemotherapy is often given through an IV in our infusion center, but it can sometimes be given through a pill.

Isolated limb profusion

This is a form of chemotherapy that is sometimes used. It allows physicians to target the blood supply in an arm or leg that is affected by a tumor. In this approach, the chemotherapy drugs are given locally so they target the circulation supply of a particular limb. This concentrates the treatment to a specific area of the body and limits the whole-body side effects.  

Radiation therapy

Radiation damages cancer cell DNA so that cells stop dividing and die. It can be used:

  • Before surgery to shrink the tumor
  • During surgery (IORT) to deliver a focused dose to the tumor bed
  • After surgery to reduce the risk of the cancer coming back. Generally, for patients with soft tissue sarcoma (STS)

External Beam Radiation (EBRT/IMRT) 

The radiation therapy most often used to treat soft-tissue sarcoma is external beam radiation therapy, meaning that radiation is delivered to the body externally from a machine. A technique called intensity modulated radiation therapy (IMRT) focuses the radiation on the tumor and lessens any impact on the patient’s healthy tissue. 

Intraoperative Radiation Therapy (IORT) 

Columbia is one of the few centers in the country that offers intraoperative radiation therapy (IORT). A large dose of radiation is given in the operating room right after the tumor is removed but before the wound is closed. This means the radiation doesn't have to travel through the healthy tissue surrounding the tumor.  

Brachytherapy

Brachytherapy (also called internal radiation therapy) is used to treat soft-tissue sarcomas. This approach places small pellets (or seeds) of radioactive material in or near the cancer using very thin catheters (tubes). The pellets deliver high doses of radiation and only stay in place for minutes at a time. In low-dose rate (LDR) brachytherapy, the pellets may stay in place for days at a time. 

Proton beam radiation 

Proton beam radiation therapy is a form of sarcoma treatment that uses protons rather than x-rays as the source of radiation, which helps protect nearby organs. Proton beam radiation therapy has been shown to be particularly effective in treating sarcomas that appear in the pelvis and back of the abdomen. Tumors in these locations can be difficult to fully remove with surgery, and because they are often positioned close to x-ray-sensitive organs like the kidneys and liver, they are difficult to treat with traditional radiation therapy as well. For these tumors, pre-surgery treatment with proton beam radiation, followed by surgery and IORT has shown to be most effective inReducing the chance of the sarcoma returning.

Targeted therapies

Targeted therapies use medications that act on specific molecules or pathways inside cancer cells that help them grow and survive. Unlike traditional chemotherapy, which affects all rapidly dividing cells, targeted drugs are designed to block only the abnormal signals that make sarcoma cells multiply. 

Your care team may recommend genetic or molecular testing of your tumor to see whether it has changes that can be treated with targeted medicines. These treatments are most often used when a sarcoma cannot be fully removed with surgery or when it has spread. For example, gastrointestinal stromal tumors (GIST) often respond well to drugs that block a gene called KIT. 

Targeted therapy is helping turn certain sarcomas into more manageable chronic conditions, offering patients new options when surgery or standard chemotherapy are less effective.

Immunotherapy

Immunotherapy helps your body’s own immune system recognize and destroy cancer cells. Because sarcoma cells can sometimes hide from immune defenses, these treatments work by “unmasking” the cancer and boosting your immune response to it. 

This approach may be recommended if your sarcoma has spread or does not respond to other treatments. Tests can show whether your tumor will be more likely to respond to immunotherapy.  Although immunotherapy for sarcoma is still being studied, it has already shown promising results for some patients. Clinical trials at Columbia are helping to expand its role in sarcoma care.

Sarcoma clinical trials at Columbia

Researchers and doctors are constantly discovering more about sarcomas and how best to treat them. Clinical trials offer access to new treatments that are not widely available.  

Columbia offers many sarcoma clinical trials for both adults and children.  Your care team at Columbia can help you determine if there is a clinical trial that may be right for you.

Learn more about clinical trials

Palliative and supportive care

Palliative and supportive care helps you manage symptoms and maintain your quality of life during and after melanoma treatment. Supportive care helps you feel as well as possible, so you can stay on treatment, and palliative care helps manage symptoms, relieve pain, and address emotional distress—for both patients and their families. Our support team offers:

  • Stent placement in sarcoma cases is usually done to relieve symptoms caused by the tumor, reduce pain, or make surgery safer and easier—for example, when removing a tumor from a major artery. 
  • Surgical bypass restores normal bile flow if a blockage can’t be opened with a stent. Bypass can relieve pain, jaundice, or help food pass around the tumor from your stomach. 
  • Ablation procedures that use targeted energy (heat or extreme cold) for select tumors when surgery isn’t possible or to treat limited spread to reduce pain. 
  • Pain management, using morphine (or other medications) or nerve blocks. 
  • Nutrition and physical therapy to support strength and mobility. 
  • Integrative therapies like acupuncture and meditation.
Learn more about support services offered by Columbia

Your treatment, your voice

At Columbia, we want your treatment plan to reflect your goals. We will discuss benefits, risks, side effects, and recovery for each treatment option so that you have all the information to make informed choices. Whatever your path, we will ensure that your care plan is built around your values, lifestyle, and priorities.

Meet your Sarcoma team at Columbia