Chemotherapy for Soft Tissue Sarcomas

Chemotherapy (chemo) is the use of drugs given into a vein or taken by mouth to treat cancer. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread (metastasized) to other organs. Depending on the type and stage of sarcoma, chemotherapy may be given as the main treatment or as an adjuvant (addition) to surgery. Different types of sarcoma respond better to chemo than others and also respond to different types of chemo. Chemotherapy for soft tissue sarcoma generally uses a combination of several anti-cancer drugs.

Chemo drugs used for sarcoma

The most commonly used drugs are ifosfamide (Ifex^®) and doxorubicin (Adriamycin^®). When ifosfamide is used, the drug mesna is also given. Mesna is not a chemo drug. It's used to protect the bladder from the toxic effects of ifosfamide.

Other chemo drugs may be used as well, including dacarbazine (DTIC), epirubicin, temozolomide (Temodar^®), docetaxel (Taxotere^®), gemcitabine (Gemzar^®), vinorelbine (Navelbine^®), trabectedin (Yondelis^®), and eribulin (Halaven^®).

When several drugs are used together, the combination is given a shortened name such as: MAID (mesna, Adriamycin [doxorubicin], ifosfamide, and dacarbazine) or AIM (Adriamycin [doxorubicin], ifosfamide, and mesna).

Isolated limb perfusion (ILP)

ILP is a different way to give chemo. The circulation of the limb (arm or leg) with the tumor in it is separated from that of the rest of the body. Chemo is then given just to that limb. Sometimes the blood is warmed up a bit to help the chemo work better (this is called hyperthermia). ILP may be used to treat tumors that cannot be removed or to treat high-grade tumors before surgery. It can help shrink tumors, but it isn’t clear that it helps patients live longer than standard chemo. ILP should only be done at centers with a lot of experience in giving chemo this way.

Chemo side effects

Chemotherapy drugs kill cancer cells but also damage some normal cells. This causes side effects. Side effects depend on the type of drugs, the amount taken, and the length of treatment. Common chemo side effects include:

• Nausea and vomiting
• Loss of appetite
• Loss of hair
• Mouth sores
• Fatigue
• Low blood counts

Because chemotherapy can damage the blood-producing cells of the bone marrow, patients may have low blood cell counts. This can result in:

• Increased chance of infection (from too few white blood cells)
• Problems with bleeding or bruising (from too few blood platelets)
• Fatigue and weakness (from too few red blood cells)

Most side effects go away over time once treatment is stopped. For instance, hair will grow back after treatment ends, but it might look different. There are treatments for many of the short-term side effects of chemo. For instance, drugs can be given that prevent or reduce nausea and vomiting.

Some chemo side effects can last a long time or even be permanent. For instance, doxorubicin can weaken the heart if too much is given. If you're going to get this drug, your doctor might check your heart function with special studies before starting this drug. The doctor will also watch your heart function during therapy.

Some chemo drugs cause nerve damage (called neuropathy), leading to numbness, tingling, or even pain in the hands and feet. For more on this, see Peripheral Neuropathy Caused by Chemotherapy.

Chemotherapy may also permanently damage ovaries or testicles, causing infertility (not being able to have children). This is covered in more detail in Fertility and Women With Cancer and Fertility and Men With Cancer.