Treatment options for soft tissue sarcoma

A team of health professionals will discuss the best treatment for you. This depends on factors such as your cancer stage and grade. You might have one or more treatments. The most common treatments are surgery, radiotherapy and chemotherapy.

Deciding what treatment you need

Most people are referred to a specialist sarcoma centre. You might go to a different hospital if there isn't a specialist sarcoma centre at your local hospital.

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The team usually includes:

• a specialist surgeon
• cancer specialists (oncologists) who treat cancer with cancer drugs (medical oncologist) and radiotherapy (clinical oncologist)
• a specialist cancer nurse (also called clinical nurse specialist)
• a pathologist who examines any cancer or tissue the surgeon removes
• a radiologist who looks at your scans and x-rays
• a palliative care doctor who specialises in controlling cancer symptoms

Your treatment depends on:

• the type of sarcoma
• where your sarcoma is
• how far it has grown or spread (the stage)
• how abnormal the cells look under a microscope (the grade)
• whether the cancer has spread to another part of the body (secondary cancer or metastases)
• your general health and level of fitness

Your MDT will discuss your treatment, its benefits and the possible side effects with you.

Surgery

Surgery is the most common treatment for soft tissue sarcoma. Surgeons aim to remove as much of the cancer as possible.

Stage 1, 2 or 3 sarcoma might be completely removed with surgery. In some situations, surgery may also be used to remove sarcoma that has spread to other parts of the body (stage 4). The different operations include:

• limb sparing surgery where the cancer is removed and not the affected limb
• amputation where the limb is partially or completely removed, but this is very rare

Radiotherapy 

Radiotherapy uses high energy rays to kill cancer cells. It is often used with other treatments for soft tissue sarcoma.

You might have radiotherapy:

• before surgery 
• after surgery
• on its own as your main treatment
• when the position of the soft tissue sarcoma makes surgery to remove it too difficult - radiotherapy aims to control the sarcoma and slow its growth

Proton beam therapy

You might have a type of radiotherapy called proton beam therapy for sarcoma in the spine or close to the spine. This type of radiotherapy uses high energy or low energy proton beams to treat cancer.

Proton beam uses a very targeted approach. This way it saves surrounding tissue from getting a dose of the radiotherapy.

Chemotherapy

Chemotherapy means using anti cancer drugs to destroy cancer cells. It is not yet clear how helpful chemotherapy is for some types of soft tissue sarcoma. So you may be asked to join a clinical trial if you are offered chemotherapy. 

Chemotherapy is not a standard treatment after surgery. This is because some research shows that it does not help reduce the risk of sarcoma coming back. This is for most types of sarcoma. 

Your specialist will discuss this with you. They are most likely to suggest chemotherapy for people with:

• large sarcomas
• high grade sarcomas
• sarcomas that are at most risk of cancer coming back 

Some people might have chemotherapy before surgery. This is called neoadjuvant chemotherapy. It aims to shrink the cancer. and make it easier to remove with surgery. This is not standard treatment. 

Doctors sometimes use a specialist technique called isolated limb perfusion. This means giving chemotherapy to the affected arm or leg. It is a very complicated technique. It is only available at a few specialist hospitals. 

For some types of sarcoma chemotherapy can be used to treat symptoms. Or it is used to control sarcoma that has spread or come back after other treatments. 

Targeted cancer drugs

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive.

People with gastrointestinal stromal tumours (GISTs) that have spread might have a drug called imatinib (Glivec). Imatinib can work very well at controlling the growth of GISTs for several years or more.

Treatment by stage

Small localised sarcoma 

Surgery is the main treatment and it might cure you. Your surgeon aims to remove the cancer and a border of healthy tissue around it. Having a border of healthy tissue lowers the risk of sarcoma coming back.

You might have radiotherapy after surgery. The aim of this is to kill any cancer cells which may have been left behind if the surgeon is unable to remove enough healthy tissue around the cancer. This may happen because the tumour is close to an important structure such as a nerve, blood vessel or bone. Radiotherapy help to stop the cancer from coming back. 

Large sarcoma that has not spread 

You may have radiotherapy before surgery, mostly for large, deep and high grade sarcomas. You may also have radiotherapy and chemotherapy before surgery. This is only done with particular types of sarcoma such as rhabdomyosarcoma and Ewing sarcoma. Some types of sarcoma do not respond so well and are less likely to shrink. You may also have radiotherapy after surgery to kill off any cancer cells that may have been left behind. 

Sarcoma that has spread 

Radiotherapy or chemotherapy (or a combination of both) aims to help keep the cancer under control for longer. And to relieve symptoms. 

Specialist surgery might be possible for sarcoma that has spread to the lungs or liver, or other parts of the body. This is not suitable for everyone. Your specialist will discuss it with you if it is an option in your situation. 

People with a type of sarcoma called a gastrointestinal stromal tumour (GIST) may have targeted cancer drugs such as:

• imatinib (Glivec)
• sunitinib (Sutent)
• regorafenib (Stivarga)

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Getting a second opinion

Some people like to get an opinion from a second doctor. This is before they decide on their treatment. Most doctors are happy to refer you to another NHS specialist if you would find this helpful.