Sarcoma treatment options
Judith K. Sato, M.D., director, Musculoskeletal Tumor Program
Sarcomas, due to their unique nature in types and locations affected, require a personalized treatment plan for the best clinical and quality-of-life outcomes. At City of Hope, our multidisciplinary team of medical experts across different fields — including surgery, radiation oncology, medical oncology, pathology, rehabilitation and supportive care medicine — will review your individual case together to determine the best course of therapy.
Our physicians are active members in many collaborations and cooperative groups, such as WEST (Western Sarcoma Team) and Children’s Oncology Group. Our team also participate in numerous clinical trials for detecting, treating and preventing sarcomas. This dedication to research means our patients have access to the most promising and leading-edge cancer therapies available.
Learn more about our sarcoma treatment options below:
Dominic Femino, M.D., chief, Division of Orthopaedic Surgery
For early stage or locally advanced sarcomas, surgical removal of cancerous tissue is the primary treatment. The type of surgery varies depending on the type, size and location of the cancer.
City of Hope offers the latest advances in sarcoma surgery, meaning you can achieve outcomes not possible elsewhere. This includes our surgeons’ innovative approaches to cancer removal, devotion to preserve normal tissues and specialized prosthetic options to maintain or restore your quality of life.
When possible, minimally invasive surgeries — which uses smaller incisions compared to a traditional open procedure — will be performed. This can significantly reduce discomfort, blood loss, hospital stay and recovery time while maintaining optimal outcomes.
Highlights of our sarcoma surgery program include:
- Limb-sparing surgery: When possible, our surgeons will aim to remove cancer without amputation to preserve mobility and quality of life. This includes:
- Minimal removal of normal tissue
- Use of metal endoprosthesis to replace bones and/or joints
- Replacing the excised area with grafts or fillers, such as bone cement
- Bone transport for reconstruction after tumor resection or to correct limb-length discrepancies
- Joint reconstruction with natural or synthetic materials
- Rotationplasty: For patients with sarcomas at or near the knee, rotationplasty is a modified amputation that replaces the knee joint with the ankle and foot (see right), which is then fitted with a lower leg prosthetic. This allows for a significantly enhanced balance, coordination and range of motion following sarcoma surgery.
- Expandable bone prostheses that uses specialized magnets to help lengthen prostheses to keep up with the patients’ growth, without requiring additional extra surgeries to manually expand (or replace) traditional bone prostheses.
- Experience in surgically addressing complex cases of sarcomas, including:
- Locally advanced cancers
- Large or disfiguring tumors
- Tumors at or near vital organs or structures
- Surgery in pediatric and young adult patients, when bone and connective tissues are still growing
- Other health conditions that can complicate surgery
Following cancer surgery, we also provide a broad range of rehabilitation services to help restore mobility and activity using a combination of physical, occupational and recreational therapy.
Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It is may be delivered externally using beams of energy focused on the tumor site, or internally by placing radioactive substances in or near the tumor site.
Radiation can treat tumors that cannot be removed by surgery (sometimes shrinking them enough to be operable) and can be used to relieve pain and other cancer symptoms. It may also be used after surgery to kill any remaining cancer cells at the tumor site to reduce likelihood of recurrence.
City of Hope is a leader in image-driven radiation planning, using advanced imaging technologies — such as computed tomography, magnetic resonance imaging and positron emission tomography scans — to determine tumor size and location, and “sculpt” radiation delivery to the cancerous areas. This ensures radiation is accurately delivered to the tumor site, while minimizing exposure to nearby normal tissues.
Drug therapy may be given to patients to fight sarcoma cells throughout the body by killing the cancer cells or stopping their growth and spread. These drugs include:
- Chemotherapy, which targets rapidly dividing cells, including cancer cells
- Targeted therapy, which selectively attacks cancer cells based on specific characteristics
- Immunotherapy, which stimulates the patient’s own immune system to recognize and attack cancer cells
The drug or drug combination used depends on the type and stage of sarcomas, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and/or less toxic.
In addition to traditional drug regimens, sarcoma patients at City of Hope may be eligible for isolated limb infusion therapy, which delivers cancer-fighting drugs directly to the affected arm or leg. This is done by applying a tourniquet to the affected limb and connecting its primary artery and vein to the drug-delivery mechanism. This allows for higher drug concentrations to be prescribed while reducing the likelihood and severity of systemic side effects, such as nausea and fatigue.
City of Hope patients may also be eligible for new, promising drugs through our clinical trials program.