The treatment options for soft tissue sarcoma include surgery, chemotherapy, radiation therapy and targeted therapies. The type of treatment you receive will depend on several different considerations, such as the type of soft tissue sarcoma you have, its grade, location and size, your overall health and your treatment preferences. These are often complex decisions and usually made in a multidisciplinary setting with different specialists involved. This page aims to give you a comprehensive overview of how soft tissue sarcoma treatment works in Malaysia’s health system.
Soft Tissue Sarcoma
Understanding treatment for soft tissue sarcoma and how it is delivered
Surgery for soft tissue sarcomaSurgery
Surgery is often the first step in treating soft tissue sarcoma and, in some cases, may be the only treatment needed. Depending on where your tumour is located, the goal is typically to surgically remove the tumour along with some of the healthy tissue surrounding it. Surgical options for the treatment of soft tissue sarcoma include:
Wide local excision
A wide local excision is used to remove sarcoma tumours and some surrounding tissue. Depending on the location of your tumour, you may receive radiation therapy or chemotherapy before surgery to shrink your tumour and make it easier to remove.
Limb-salvage surgery
The goal of limb-salvage surgery is to remove all of the cancer and some surrounding tissue while leaving the limb intact.
Amputation
During this procedure, all or part of an arm or leg is removed along with the cancerous tumour/s. In cases where the cancer is very large or located in a complicated area, partial or complete amputation may be required. However, amputation is becoming a less common practice with the development of more modern treatment options.
Lymphadenectomy
Also referred to as a lymph node dissection, a lymphadenectomy is the surgical process of removing lymph nodes near the tumour that are enlarged and may contain cancer.
Radiation therapy for soft tissue sarcomaRadiation therapy
Soft tissue sarcoma patients who are suitable for radiation therapy may receive either external beam radiation therapy or brachytherapy to increase the effectiveness of other treatments. In most cases, radiation therapy is given either before or after surgery as an adjuvant treatment. When delivered before surgery, the goal is to shrink the tumour to make it easier to remove. After surgery, radiation therapy is used to destroy any remaining cancer cells.
External beam radiation therapy
External beam radiation therapy (EBRT) is used to treat soft tissue sarcoma by delivering highly targeted radiation therapy beams to cancerous tumours. The most common EBRT techniques which are used to treat soft tissue sarcoma include:
Brachytherapy
Also known as internal radiation therapy, brachytherapy uses a small radioactive source to treat your soft tissue sarcoma by placing the material inside or near your tumour.
Proton beam therapy for soft tissue sarcomaProton beam therapy
Proton beam therapy is an advanced treatment which may be used to treat soft tissue sarcomas. By targeting the cancer with a precise beam of protons, proton beam therapy treats the cancer without affecting surrounding health organs such as the kidneys, reducing the impact of side effects. Proton therapy can be used to treat many types of sarcomas in children and adults, particularly in difficult to treat areas such as the base of the skull and spine.
Targeted therapy for soft tissue sarcoma Targeted therapies
Targeted therapies use specialised drugs to destroy specific proteins in soft tissue sarcoma cells, while leaving healthy cells intact. These drugs aim to stop soft tissue sarcoma cells from repairing themselves when they get damaged.
Common targeted therapy medicines
There are several different medicines available for targeted therapy to treat soft tissue sarcoma. They may be combined based on the type of soft tissue sarcoma you have, your cancer’s stage and how much it has spread. Some of the medicines used include a tyrosine kinase inhibitor that blocks protein targets on the surface of sarcoma cancer cells, including the vascular endothelial growth factor receptor (VEGFR). By blocking the VEGFR, the cancer cells no longer get the nutrients they need to grow and spread. It is used to treat soft tissue sarcoma when other treatments have been ineffective and is taken orally as a tablet once daily.
Chemotherapy for soft tissue sarcomaChemotherapy
Chemotherapy uses a range of drugs to kill and slow the growth of soft tissue sarcoma cells. To treat soft tissue sarcoma, chemotherapy may be used as an initial treatment or as an adjuvant treatment after surgery depending on the type and stage of your sarcoma.
When you are diagnosed with soft tissue sarcoma, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the stage of your cancer. Most treatment plans for soft tissue sarcoma begin with surgery, however, for sarcomas that are not located in a limb, additional treatment options may be considered first.
Common treatment options for soft tissue sarcoma by stage include:
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Stage I soft tissue sarcoma
For early-stage soft tissue sarcoma that is confined to a limb and is less than five cm in size, surgery is usually the only treatment needed. In some cases, your doctor may recommend radiation therapy after surgery to ensure no cancer cells remain.
If your sarcoma is located anywhere besides a limb, radiation therapy or chemotherapy may be delivered first to shrink the tumour and make it easier to remove.
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Stage II and III soft tissue sarcoma
Stage II and III soft tissue sarcoma is typically treated similarly to stage I, however these tumours are often considered high-grade and tend to grow and spread more quickly. During surgery, the tumour and some healthy tissue will be removed including the surrounding lymph nodes. For larger tumours, chemotherapy or radiation therapy may be delivered first to shrink the tumour and make it easier to remove.
Depending on factors such as the size and location of the cancer and your overall health, radiation therapy may be used as the primary course of treatment when surgery is not possible.
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Stage IV soft tissue sarcoma
Treatment for advanced soft tissue sarcoma begins with surgery to remove as much cancerous tissue as possible. However, stage IV soft tissue sarcoma that has spread to distant parts of the body is considered very difficult to cure and, in many cases, treatment will focus on palliative care to manage your pain and symptoms. Chemotherapy, radiation therapy and targeted therapies may be used to relieve symptoms of your cancer.
ReferencesReferences
For a full list of references, click here.
- American Cancer Society. (2020, January 31). Surgery for soft tissue sarcomas. American Cancer Society. Retrieved January 11, 2022, from cancer.org/cancer/soft-tissue-sarcoma/treating/surgery.html
- National Cancer Institute. (2020, May 6). Adult soft tissue sarcoma treatment. National Cancer Institute. Retrieved January 11, 2022, from cancer.gov/types/soft-tissue-sarcoma/patient/adult-soft-tissue-treatment-pdq
- American Cancer Society. (2020, January 31). Chemotherapy for soft tissue sarcomas. American Cancer Society. Retrieved January 11, 2022, from cancer.org/cancer/soft-tissue-sarcoma/treating/chemotherapy.html
- American Cancer Society. (2020, January 31). Radiation therapy for soft tissue sarcomas. American Cancer Society. Retrieved January 11, 2022, from cancer.org/cancer/soft-tissue-sarcoma/treating/radiation-therapy.html
- American Cancer Society. (2020, January 31). Treatment for soft tissue sarcomas, by stage. American Cancer Society. Retrieved January 11, 2022, from cancer.org/cancer/soft-tissue-sarcoma/treating/by-stage.html
- Trabectedin for soft tissue sarcoma. Aust Prescr 2021; 44:176. First published 11 August 2021. https://doi.org/10.18773/austprescr.2021.040
- European Society of Medical Oncology (ESMO). (2016). Patient Guides. Soft Tissue Sarcoma. Retrieved 21 February from https://www.esmo.org/for-patients/patient-guides/soft-tissue-sarcomas
- Sing Health. (2021). Soft tissue sarcomas. Retrieved on 6 April 2022 from https://www.healthxchange.sg/video/cancer/cancer-soft-tisuse-sarcoma-gastrointestinal-stromal-tumour#:~:text=The%20condition%20is%20called%20Sarcoma,180%20new%20sarcoma%20patients%20annually.
- UF Health. (2022). Proton therapy doe Sarcoma treatment. Retrieved on 14 April 2022 from https://www.floridaproton.org/cancers-treated/sarcoma
- Pub med. (2017). The Evolving Role of proton beam therapy for Sarcomas. Retrieved on 14 April 2022 from https://pubmed.ncbi.nlm.nih.gov/28506520/
- Science Direct. (2021). Early Experience Using Proton Beam Therapy for Extremity Soft Tissue Sarcoma: A Multi-Institution Study. Retrieved on 14 April 2022 from https://www.sciencedirect.com/science/article/abs/pii/S0360301621018502
- American Cancer Society. (2018). Radiation Therapy for Soft Tissue Sarcoma. Retrieved on 14 April 2022 from https://www.cancer.org/cancer/soft-tissue-sarcoma/treating/radiation-therapy.html
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