Sarcoma is a rare and complex cancer that requires a team of experts in surgery, medical oncology, radiation, orthopedic oncology, neurosurgery, and reconstructive plastic surgery. At Columbia Cancer, we bring all these experts together to find the best treatment for you.
Our commitment to our patients and our time-tested expertise means high success rates. Our surgeons perform specialized operations to remove cancerous tissue while preserving as much healthy tissue as possible. Our medical oncologists are leading the way in new treatments for sarcoma, like immunotherapy and targeted therapy, and we have a wide range of clinical trials specifically for sarcoma patients. Our radiation oncologists use state-of-the-art technologies to deliver precise radiation therapy that destroys cancer cells without harming surrounding cells.
Your care team will discuss your treatment options with you so you can make the best decision for you. You may have any combination of surgery, medication treatments, and radiation treatments. You may also be eligible for a clinical trial of new therapies and drugs.
Surgery is the first line of treatment for soft-tissue sarcomas of the abdomen and uterus. Other types of sarcoma may require chemotherapy and/or radiation beforehand to shrink the size of the tumor before operating. If surgery is recommended for you, your care team will speak with you about your options and customize a plan that works for you.
The goal of limb-sparing surgery is to preserve as much of the muscles, ligaments, and nerve as possible. 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.
After the tumor is removed, surgeons may use the following techniques to restore limb function.
Some bone repairs can be accomplished using freeze-dried cadaver bones. This material is packed into small areas in the patient’s bones after tumor removal, rather like plastering over a defect in a wall. Whole cadaver bones can be used to replace sections of the patient’s pelvis or larger bones. These then serve as scaffolding as the patient’s own bones begin to grow and cover the cadaver bone. Because allografts are associated with a high risk of infection and can also break down over time, surgeons are developing a new technique that provides the mid-bones with a critical blood supply.
A prosthesis is an artificial body part. A metal rod is used more frequently than cadaver bones when treating children affected by sarcoma. The reason: Additional sections can be added to the rod as the child’s body grows. Over time, however, the metal devices may begin to loosen. For this reason surgeons sometimes combine allografts with metal inserts.
New expandable devices have been designed that actually mimic the growth of a child’s own healthy limbs. This type of prosthesis expands on its own, therefore sparing the patient several additional surgeries. This approach relies upon an electromagnetic field generated on the skin near the implant. This resulting heat releases a coiled spring inside the implant, and the device expands without any surgical intervention. This procedure can be performed on an outpatient basis, at required intervals.
In this technique, also used in children, small calf bones called the fibula are used to repair or replace an arm bone that has been affected by sarcoma. A portion of the patient’s own fibula is harvested, thereby reducing the chances of infection.
Chemotherapy can be used before surgery to shrink the size of the tumor, which increases the chance of removing the whole cancer. When chemotherapy is given before surgery, it is called neoadjuvant therapy. Chemotherapy is also used when the tumor has spread to other organs or parts of the body. Not all sarcomas respond well to chemotherapy, so the decision to proceed with it must be made between a patient and a doctor with expertise in this disease.
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 “systemic” medicine—it interferes with all fast-dividing cells in your body. This is why it causes side effects like hair loss.
Chemotherapy is often given through an IV in our infusion center, but it can sometimes be given through a pill.
Types of chemotherapy used to treat sarcomas include: doxorubicin (adriamycin), liposomal doxorubicin (doxil), gemcitabine (Gemzar), docetaxel (taxotere), ifosfamide (Ifex), cyclophosphamide (Cytoxan), vincristine, etoposide (VP-16), methotrexate (specifically for osteogenic sarcoma), and decarbazine (DTIC). These drugs can be used alone or in combination, and are at times selected based on the specific sarcoma subtype being treated. There is also a recently approved drug called pazopanib (votrient) which is an oral form of therapy. For GIST, the C-kit inhibitors include imatinib (Gleevac), sunitinib (Sutent), and more recently regorafenib.
Isolated limb perfusion: 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. You might receive chemotherapy as part of your cancer treatment. Your care team will help you make the complex decision of having chemotherapy before or after surgery to make your tumor operable. The decision depends on your cancer’s specific characteristics and the therapy’s chance to maximize survival.
Radiation therapy causes cancer cells to break or die by targeting the DNA with high-energy particles, such as X-rays, gamma rays, electron beams, or protons.
Radiation therapy is sometimes used before surgery. When this approach is necessary, the wound may not heal as well. Plastic or reconstructive surgeons are brought in to address any structural problems, after the tumor is removed.
Radiation may also be prescribed after surgery for patients with soft-tissue sarcomas (STS) to reduce their risk of recurrence. When treated by surgery alone, STS is more likely to grow back at the original site.
When offering treatment postoperatively, radiation oncologists can employ a smaller dose and target its delivery more precisely, reducing the patient’s overall exposure. Another advantage of this approach is that it reduces side effects like scarring, stiffness, or swelling of a limb.
The radiation most commonly used to treat soft-tissue sarcoma is external beam radiation therapy, meaning that radiation is delivered to the body 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.
Another option is intraoperative radiation therapy (IORT), available only at a few select centers in the nation, including Columbia Cancer. 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 issue sounding the tumor. Often, after IORT the patient receives some other type of radiation after surgery as well.
Brachytherapy (also called internal radiation therapy) is also used to treat soft-tissue sarcoma. 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.
Like chemotherapy, radiation therapy can be given before surgery, after surgery, or both. Before surgery, the goal is to shrink the tumor, making it easier for the surgeon to remove. After surgery, the goal is to destroy any remaining cancer cells.
Sometimes for sarcoma there are no standard, effective therapies. In these cases, you may qualify to be treated in a clinical trial with an investigational therapy. In clinical trials, the latest advances in cancer therapy are offered. Many of these trials are now based on drugs that specifically target the unique characteristics of the cancer cell.
Columbia Cancer offers many sarcoma clinical trials. You can talk to your care team about whether a clinical trial is an option for you.
If your cancer has spread and cannot be removed by surgery, our goal is to relieve your symptoms and improve your quality of life. Palliative care can include:
- Stent placement, an endoscopic procedure to physically open a blocked bile duct. Plastic stents are a short-term solution for people who might have an operation in the future. Metal stents are more permanent.
- Surgical bypass, which 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.
- Pain management, using morphine (or other medications) or nerve blocks.