Sarcoma Cancer Treatment at Winship Cancer Institute of Emory University
There is an inherent complexity in managing patients with STS due in great part to the fact that they are rare tumors with multiple histological subtypes originating from various anatomical sites. Numerous factors are taken into consideration when determining an appropriate, individualized treatment plan for a patient with a newly diagnosed or recurrent sarcoma. Key factors include tumor size, tumor location, and aggressiveness (grade) of the tumor and whether or not the tumor has spread to other parts of the body (stage). The patient's general health and personal wishes also play a key role in deciding treatment plans. Often, the treatment of sarcoma involves a multidisciplinary approach, including:
For this reason, Winship Cancer Institute brings together specialists in radiation oncology, medical oncology, surgical oncology, orthopedic oncology, sarcoma pathology, and radiology to work together to treat sarcomas. Specialists in nursing, pharmacy, social work, nutrition support, pastoral care, and physical therapy complete the team. Multidisciplinary conferences are held regularly to discuss complex cases and to develop individualized treatment plans.
Sarcoma Tumor Surgery
Limb-sparing surgery with preservation of limb-function, with or without radiation therapy, is the standard surgical approach to patients with sarcomas. The tumor, along with a margin of normal tissue around it, is removed in its entirety. In the past, amputation was the standard surgical approach, but with new limb sparing procedures, amputation can be often avoided. For tumors that are in the abdomen or retroperitoneum, surgery can be complicated if the cancer is affecting vital organs.
Surgery is also used to remove tumors that have spread (metastasized). While surgery cannot cure the cancer, removal of tumors that have spread to the lungs can sometimes help in long-term survival especially if there is no other evidence of the cancer.
Chemotherapy Treatment for Sarcoma Cancer
Chemotherapy is medication given to eliminate cancer cells or greatly reduce their effect. It targets cells that divide rapidly, a characteristic of many cancer cells. It is used alone or along with other types of treatment to make them more effective. Chemotherapy interferes with the division and reproduction of cells. If a cell cannot reproduce, it eventually dies without another cell to replace it.
Chemotherapy is usually administered orally or intravenously and will include several different medicines. Some types are delivered daily over a prescribed period, while others are given weekly. Similarly, some chemotherapy infusions last only a few minutes, while others take all day.
Chemotherapy is commonly used in the treatment of sarcoma. If the tumor is large, it can be used to shrink the cancer before surgery to make removal easier and cause less damage to normal structures. If the tumor is a high grade (very aggressive) it has a higher likelihood of metastasizing (spreading) or if the surgery does not remove all of the cancer, then chemotherapy will often be used before and after surgery. Also, pathologists will also look at the tumor when it is removed and determine how much of the tumor was destroyed by the preoperative chemotherapy. If the percentage is low, additional chemotherapy may be advised.
Many of the chemotherapy regimens used for sarcoma will be given over several days. Sometimes this requires that the patient be admitted to the hospital but sometimes patients can use a small infusion pump that is carried in a fanny pack. These pumps can be programmed to deliver the chemotherapy over several days. Several of the drugs used to treat sarcoma are: doxorubicin, ifosfamide, cisplatin, methotrexate, gemcitabine, docetaxel, cyclophosphamide, dacarbazine and vincistine.
Patients are monitored closely for side effects and medications can be given to help reduce them. For example, some of the chemotherapy can cause nausea if vomiting, but there are new drugs that can reduce or stop nausea and vomiting. Chemotherapy drugs can affect the blood producing cells in the bone marrow. Drugs are often given to boost production of the red blood cells and white blood cells.
Radiation Therapy Treatment for Sarcoma Cancer
Radiation therapy is the use of penetrating beams of high-energy waves or streams of particles called radiation to treat disease. Radiation has been used to treat cancer since the late 19th century. In fact, the first successful radiation treatment for cancer was reported in 1898.
Radiation therapy destroys the ability of cancer cells to grow and divide. When high-energy ionizing radiation is given as cancer therapy, some cells are directly damaged, but more cells are indirectly affected by the radiation. The rays or particles enter the cell's nucleus, interact with water present in the nucleus, and form a free radical called hydroxyl radical. The hydroxyl radical is unstable and causes damage to the cell's DNA. Due to this damage, some cells die immediately. Some cells will survive in the short-term, but are unable to divide and will die at the time of mitosis, or cell division.
Radiation therapy is sometimes used as the main treatment for sarcoma, but is often used in combination with other therapies, like chemotherapy and surgery, to help improve treatment results. For example, it can be used after surgery for tumors that are considered high risk of coming back. This will help kill any cancer cells that may remain.
Normal, healthy tissues are affected by radiation therapy as well, and this accounts for the adverse side effects seen with this type of treatment such as skin irritation. To help minimize side effects, radiation is divided into doses and spread out over time. In addition, radiation is targeted as much as possible to shield normal tissues and only irradiate the cancer cells.
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