Sarcoma

Treatment

Sarcoma is often hard to treat, so it’s important to receive care at a specialized center with sarcoma expertise. Fred Hutchinson Cancer Center experts offer comprehensive, team-based soft tissue sarcoma treatment as well as bone cancer treatment, including advanced therapies and new options available only through clinical studies.

In most cases, you have time to consider your options and get a second opinion — even a third opinion — before deciding what kind of treatment is right for you. A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease.

Sarcoma expertise at Fred Hutch

Everything you need is here

We have surgeons, medical oncologists and radiation oncologists who specialize in sarcoma; the most advanced diagnostic, treatment and recovery programs; and extensive support. Every year we treat more sarcoma patients than any other cancer center in the region.

Radiation oncologist A physician who has special training in using radiation to treat cancer.

Innovative sarcoma therapies

Fred Hutch offers a range of clinical studies that may be appropriate for your type of sarcoma. Patients who participate in clinical studies have the first chance to benefit from treatments that have shown promise in earlier research.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease.

Sarcoma treatment tailored to you

We view treatment as a collaborative effort. Your Fred Hutch doctors will explain all your options and recommend a treatment plan based on the size, location, grade and subtype of your tumor; whether it has spread; and the possible impact of treatment on your body and general health.

Grade In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. Grading systems are different for each type of cancer. They are used to help plan treatment and determine prognosis. Also called histologic grade and tumor grade. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

A team of experts all in one place

We bring everyone to you — your surgeon, medical oncologist and radiation oncologist — on the same day whenever possible. Your personal team will talk with each other and with you to help you make treatment decisions. Additional experts who specialize in treating people with cancer will be involved in your care if you need them — experts like a palliative care professional, social worker, physical therapist or dietitian.

Learn More About Supportive Care Services

Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation.

Setting the standards for care

Not only do our doctors provide the most advanced sarcoma treatment, they also help set the internationally recognized standards by which others treat this disease through our membership in the National Comprehensive Cancer Network.

Ongoing care and support

After treatment, your team continues to provide follow-up care on a schedule tailored to you. The Fred Hutch Survivorship Clinic is also here to help you live your healthiest life as a sarcoma survivor.

Treatment types

Treatment looks different for different people depending on your diagnosis. We tailor your treatment plan to you. Learn more about the treatment types offered at Fred Hutch.

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

This treatment is for people with sarcoma that has spread to the abdominal lining (peritoneum). Cancer that has spread here is called peritoneal carcinomatosis, or peritoneal cancer.

CRS-HIPEC may be able to control advanced disease while also giving you good quality of life. It combines two parts in one operation:

A surgery to remove all the cancer that surgeons can see
Chemotherapy, in liquid form, that is warmed and then put into your abdomen to kill any cancer cells left behind after surgery

Fred Hutch has an experienced team that provides CRS-HIPEC.

Learn More

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

This treatment is for people with sarcoma that has spread to the abdominal lining (peritoneum). Cancer that has spread here is called peritoneal carcinomatosis, or peritoneal cancer.

Chemotherapy

Chemotherapy is a major and important component of sarcoma care. It may be given before or after sarcoma surgery to reduce the risk of the cancer coming back or to allow complete surgical removal when this would otherwise be difficult. Chemo may also be used to reduce the size of tumors or to relieve pain and other symptoms.

Many chemotherapy medicines are given through an intravenous (IV) line in repeating cycles. There are also chemotherapy treatments for sarcoma given in tablet form.

Your Fred Hutch team will talk with you about the specific medicines we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout Fred Hutch.

Learn more about chemotherapy in our medical oncology section.

Chemotherapy

Proton therapy

Proton therapy is an especially important treatment option if:

The tumor is located close to critical organs
The patient is trying to preserve particular functions, such as fertility
A patient has had prior radiation
The disease is recurrent

Recurring sarcomas may appear in different locations around the body over time. Protons can spare healthy tissue surrounding the tumor and minimize the area exposed to radiation. This is especially important if treatment is required several times over a life expectancy of many years.

The images above show a comparison plan between proton therapy (top) and standard radiation (bottom) for leiyomyosarcoma of the left buttock. In this scenario, the reproductive organs are spared from harmful radiation.

Sarcomas that may be appropriate for proton therapy:

Chordoma
Leiomyosarcoma
Liposarcoma
- Myxoid liposarcoma
- Well-differentiated liposarcoma
- Dedifferentiated liposarcoma
- Pleomorphic liposarcoma
Undifferentiated pleomorphic sarcoma
Myxofibrosarcoma
Fibrosarcoma
Clear cell sarcoma
Angiosarcoma
Chondrosarcoma
Ewing’s sarcoma
Malignant peripheral nerve sheath tumor
Rhabdomyosarcoma
Synovial sarcoma
Gastrointestinal stromal tumor
Many childhood sarcomas

Gastrointestinal Refers to the stomach and intestines. Also called GI.

Proton therapy

Proton therapy limits radiation exposure to healthy tissue and helps preserve additional treatment options for recurrences.

Radiation therapy

You may have radiation therapy before or after surgery to reduce the risk of your sarcoma coming back. If your tumor cannot be removed surgically, doctors may use radiation therapy to control it. Radiation may also be used to reduce the size of the tumor or to relieve pain and other symptoms.

We've opened several studies looking at combinations of radiation therapy and immunotherapy — using radiation to make immunotherapy more effective, increasing the body's immune response against cancer.

Conventional external-beam radiation therapy (EBRT)

Conventional EBRT uses a machine called a linear accelerator to send beams of high-energy X-rays (photons) toward the cancer. Typically, EBRT is given five days a week (Monday through Friday) for several weeks. The procedure is painless, and each treatment lasts only a few minutes.

There are several forms of EBRT. Your radiation oncologist will determine the form that’s most appropriate for your tumors, set the dosage and schedule for your treatments and help you manage any side effects. Learn more about EBRT.

Intraoperative radiation therapy (IORT)

IORT is a fast, effective and precise form of radiation used during surgery to treat tumors. It may be used to treat tumors that came into contact with the tumor during surgery.

IORT takes just a few minutes to deliver and uses only a fraction of the total radiation given over a traditional multi-week course of EBRT. UWMC is the only hospital in the WWAMI region (Washington, Wyoming, Alaska, Montana and Idaho) to offer this treatment. Learn more about IORT.

Proton therapy

Proton therapy delivers radiation with great precision, significantly limiting radiation exposure to surrounding healthy tissues. This may reduce side effects from treatment and make proton therapy a better choice for certain sarcomas that are anatomically complex, such as those in the skull or spine. Learn more about proton therapy.

Fast neutron therapy

Neutron therapy bombards cancer cells with neutrons. There are two advantages to using neutrons instead of photons or electrons.

Neutron beams are much more powerful. They deposit about 20 to 100 times as much energy into the target tissue.
Neutron beams are more likely to damage both strands of a cancer cell’s DNA, rather than only one strand, making it harder for the cells to repair themselves and survive.

UWMC is the only place in the United States to offer neutron therapy, and doctors here are internationally recognized for their neutron therapy expertise. We sometimes use neutron therapy to treat sarcomas when we believe this may be more effective than conventional forms of radiation therapy. Read more about fast neutron therapy on the UW Medicine website.

Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

Radiation therapy

Surgery

Surgery is the most common treatment for sarcoma, and it may be curative for some people. Chemotherapy, radiation therapy or both may be given before or after surgery to reduce the risk of the cancer coming back.

UW Medicine surgeons who provide care at both Fred Hutch and University of Washington Medical Center perform surgery for our sarcoma patients. They perform more surgeries on adults with sarcoma than surgeons at any other cancer center in the Northwest.

We offer leading-edge options, including limb-sparing surgery, bone transplants and metallic implants, if you need them, and we use minimally invasive techniques, such as laparoscopic surgery (through small "keyhole" incisions), whenever possible.

The exact surgery you need will depend on many factors, including the location and size of your tumor. Your team will explain:

The details of your procedure
The benefits and risks
How to prepare before surgery
What to expect during your recovery and beyond

During surgery, intraoperative ultrasound helps our surgeons better delineate, or see the exact location of, the borders of your tumor. This means they can more effectively remove the whole tumor while saving healthy structures nearby. If your sarcoma surgeon needs to take out soft tissue or bone to remove a tumor, our reconstructive surgeons can help restore the area. They may use neighboring soft tissue (local tissue rearrangement) or tissue from another part of your body (flap reconstruction). When bones are involved, UW Medicine orthopedic surgeons offer procedures such as bone transplants, joint replacements and metallic implants. After your surgery, your care team follows evidence-based guidelines to help your recovery ("early-recovery after surgery" protocols).

Sometimes, a tumor cannot be removed surgically because of its size, location or how aggressive it is. In these cases, a multidisciplinary team can plan another course of treatment to control the sarcoma, reduce its size and relieve pain and other symptoms.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Laparoscopic surgery A surgery done with the aid of a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Surgery done with the aid of a laparoscope. A laparoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Ultrasound A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen. A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram). Ultrasound may be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures, such as biopsies. Also called ultrasonography.

Surgery

Targeted therapy and immunotherapy

Targeted therapies are another type of medicine that can be used in sarcoma treatment. They target a gene or protein responsible for allowing cancer to grow, they seek out and damage cancer cells, or they prompt your immune system to attack particular cells (also called immunotherapy).

Targeted therapies for sarcoma include:

For bone cancer — denosumab (Xgeva)
For soft tissue sarcoma — olaratumab (Lartruvo) and pazopanib (Votrient)

There are many different types of sarcoma, and other targeted therapies are used to treat particular types, such as:

For gastrointestinal stromal tumors — imatinib (Gleevec), sunitinib (Sutent) and regorafenib (Stivarga), as well as pazopanib
For desmoid tumors — sorafenib (Nexavar)

Fred Hutch has one of the most comprehensive sarcoma immunotherapy research programs anywhere. We have multiple immunotherapy clinical trials, testing a wide range of options, such as T-cell therapy, immune checkpoint inhibitors, vaccines, virus therapies, additional antibody therapies and other medicines that boost the body’s anti-cancer immune response.

Learn more about immunotherapy.

Antibody A protein made by immune system cells and released into the blood. Antibodies defend the body against foreign substances, such as bacteria. Gastrointestinal Refers to the stomach and intestines. Also called GI. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.

Targeted therapy and immunotherapy

Noncancerous bone and joint treatment

At Fred Hutch, our orthopedic oncology team is highly experienced in treating both cancerous and noncancerous (benign) bone and soft tissue tumors.

If you are diagnosed with a benign bone or soft tissue tumor, our orthopedic oncologists at the Sarcoma and Orthopedic Surgical Oncology Clinic at Fred Hutch offers thoughtful expertise in evaluating your condition with a full range of treatment options to care for you.

With specialized expertise in the surgical management of bone and soft tissue tumors, access to the latest treatment options, and expertise in complex limb and pelvis reconstruction, our team provides the highest level of care for rare and/or complicated tumors of the musculoskeletal system.

Benign Not cancer. Benign tumors may grow larger but do not spread to other parts of the body.

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About benign bone and soft tissue tumors

Although some bone tumors are cancerous, most are not. Benign tumors usually do not spread or become life-threatening. However, they can grow aggressively and cause complications such as pain, fracture, or injury to other body parts; or, in rare circumstances, become cancerous.

Because these tumors are rare, many general or even specialized physicians may never see or learn about them, and therefore it is important that you seek a comprehensive evaluation by an expert in bone and soft tissue tumors. Management can range from observing the tumor over time to make sure it does not change to removing it with surgery.

Benign Not cancer. Benign tumors may grow larger but do not spread to other parts of the body.

Sarcoma and Orthopedic Surgical Oncology Clinic

South Lake Union clinic

phone (206) 606-2018

phone (855) 557-0555

Hours: Monday–Friday, 8 am - 5 pm

fax (206) 606-8299

Types of noncancerous tumors

Benign bone tumors

Common benign bone tumors we treat at Fred Hutch include:

Aneurysmal bone cyst
Chondroblastoma
Chondromyxoid fibroma (CMF)
Enchondroma (including Ollier disease and Maffucci syndrome)
Fibrous cortical defect and non-ossifying fibroma (NOF)
Giant cell tumor (GCT) of bone
Histiocytosis of bone
Osteoblastoma
Osteochondroma and multiple hereditary exostoses (MHEs)
Osteoid osteoma
Osteoma
Periosteal chondroma
Unicameral bone cysts/Solitary bone cyst

We also treat rare conditions of the bone, such as:

Benign vascular tumors of bone
Bone Infarcts/Avascular necrosis of bone
Eosinophilic granuloma (EG)
Fibrous dysplasia
Melorheostosis
Osteofibrous dysplasia
Paget’s disease

Benign Not cancer. Benign tumors may grow larger but do not spread to other parts of the body. Hereditary In medicine, this describes the passing of genetic information from parent to child through the genes in sperm and egg cells. Also called inherited. Nonmalignant Not cancer. Nonmalignant tumors may grow larger but do not spread to other parts of the body. Also called benign. Ollier disease A rare disorder that causes benign (not cancer) growths of cartilage in the bones.

A rare disorder that causes benign (not cancer) growths of cartilage in the bones. These growths usually occur in the bones of the hands and feet, but they may also occur in the skull, ribs, and spine. They may cause bones to break, to be deformed, or to be shorter than normal.

Maffucci syndrome A very rare disorder that affects the skin and cartilage. It is marked by benign (not cancer) growths of cartilage in bones.

A very rare disorder that affects the skin and cartilage. It is marked by benign (not cancer) growths of cartilage in bones. These growths usually occur in the hands or feet, but may also occur in the skull, ribs, and spine. They may cause severely deformed bone, shortening of the arms or legs, broken bones, and other bone problems.

Benign soft tissue tumors

Benign soft tissue tumors we treat at Fred Hutch include:

Lipoma/Atypical lipomatous tumors
Extra-abdominal desmoid tumor
Fibroma and fibromatosis
Ganglion and synovial cysts
Glomus tumors
Hemangioma/Vascular malformation
Myositis ossificans/Heterotopic ossification
Myxoma
Neurofibroma (neurofibromatosis)
Neuroma
Pigmented villonodular synovitis (PVNS)
Schwannoma/Neurilemmoma
Synovial chondromatosis

Benign Not cancer. Benign tumors may grow larger but do not spread to other parts of the body.

Complex bone and soft tissue reconstruction

Complex limb reconstruction (or “limb salvage surgery”) is a type of orthopedic surgery. These surgeries are complicated and must be done by experts. At Fred Hutch, we use these highly-advanced surgeries to make major repairs to a bone or joint that that has been damaged by tumors of the bones and soft tissues, trauma or failed prior reconstructive procedures. The goal of these surgeries is to keep as much movement in your limb as possible.

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