Treatment

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 SCCA 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 the borders of your tumor to more effectively remove the whole tumor while saving healthy structures nearby. After your surgery, your care team follows evidence-based guidelines to enhance your recovery ("early-recovery after surgery" protocols).

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

Learn more about surgical oncology.

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 SCCA 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 SCCA.

Learn more about chemotherapy in our medical oncology section. 

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)

SCCA 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.

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.

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

SCCA has an experienced team that provides CRS-HIPEC.