Treating Soft Tissue Sarcomas

Stage I soft tissue sarcomas are low-grade tumors of any size. Small tumors (less than 5 cm or about 2 inches across) of the arms or legs might be treated with surgery alone. The goal of surgery is to remove the tumor with some of the normal tissue around it.

If cancer cells are found in or near the edges of the tissue removed (called positive or close margins), it can mean that some cancer was left behind. Often the best option for positive or close margins is more surgery. Another option is treating with radiation therapy after surgery. This lowers the chance of the cancer coming back.

If the tumor is in the head, neck, or abdomen, it can be harder to take out. For these tumors, radiation with or without chemotherapy (chemo) might be given before surgery. This might shrink the tumor enough to remove it entirely with surgery.

If radiation is not used before surgery, it might be given after surgery to help lessen the chance that the tumor will come back.

Most stage II and III sarcomas are high-grade tumors. They tend to grow and spread quickly.

Some abdominal or retroperitoneal stage III tumors have already spread to nearby lymph nodes. Even when these sarcomas have not yet spread to lymph nodes, the risk of them spreading to lymph nodes or other parts of the body is very high.

These tumors also tend to grow back in the same area after they're removed. This is called local recurrence.

For all stage II and III sarcomas, treatment can involve both radiation and surgery.  Radiation is often given prior to the surgery.  Lymph nodes will also be removed if they might contain cancer.

If the tumor is large or in a place that would make surgery difficult, the patient might be treated with chemo, radiation, or both before surgery. The goal of treatment is to shrink the tumor, making it easier to remove. For large tumors in the arms or legs, giving chemo by isolated limb perfusion is also an option.

Chemo, radiation, or both might also be given after surgery. These treatments lower the chance of the tumor coming back in or near the same place it started.

In rare cases, amputation of part or all of a limb might be needed to remove the entire tumor. This is done much less often now than it was in the past.

Radiation therapy with or without chemo can be used alone when the tumor's location or size or the patient's overall health makes surgery impossible.

A sarcoma is considered stage IV or metastatic when it has spread to distant parts of the body. Stage IV sarcomas are rarely curable. Some patients might be cured if the primary (main) tumor and all of the areas of cancer spread (metastases) can be removed by surgery.

The best success rate is when it has spread only to the lungs. In this case, the main tumors are treated as in stages II or III, and metastases are removed completely, if possible. This is still an area where doctors disagree about what the best treatment is, and which patients are most likely to benefit.

For people whose primary tumor and all metastases cannot be removed completely by surgery, radiation therapy and/or chemotherapy are often used. For some types of soft tissue sarcomas, treatment with targeted therapy or immunotherapy drugs might also be an option.

Cancer recurrence is when cancer comes back after treatment. Recurrence can be:

• Local, in or near the same place it started
• Distant, spread to other organs or tissues, such as the lungs or brain

A local recurrence might be treated with radiation and surgery, if radiation wasn't used during the original treatment. Or it might be treated with surgery alone. If external beam radiation was used before, brachytherapy might still be an option depending on the location of the tumor.

If it’s a distant recurrence, chemo, targeted therapy, or immunotherapy drugs might be options. If the sarcoma has spread only to the lungs, it might be possible to remove all the areas of spread with surgery. Radiation is often used to treat sarcomas that have spread to the brain, as well as any recurrences that cause symptoms such as pain.