Sarcoma

Surgery to remove the tumor is the mainstay of treatment for bone and soft tissue sarcoma. At Hollings, we have a special focus on preserving limbs and avoiding amputation.

Treatment options depend on the specific diagnosis, tumor genetics, where the tumor is located, and individual patient factors. Because surgery to remove the tumor might also require removing a section of bone, we have several options for reconstruction. Surgical options or reconstruction include:

• Endoprosthetic replacement. An endoprosthesis is an artificial device implanted into your body to replace bone that was removed. Your remaining, living bone will grow and attach to the endoprosthesis, forming a strong foundation for daily living.
• Extendible endoprosthesis. Children who are still growing have special treatment needs. If bone must be removed from a leg, an extendible endoprosthesis can be lengthened during office visits, at home, and/or in the operating room as the child grows. This avoids the need for multiple surgeries to replace the endoprosthesis.
• Donor bone. Sometimes, instead of an endoprosthesis, a donor bone might be the best option to replace bone removed during surgery. This donor bone could be your own or it could be an organ donor’s. The doctor uses plates and screws to attach the donor bone to the patient’s own bone. Just like with the endoprosthesis, your living bone will grow and find places in the donor bone to attach, creating a secure foundation.

Surgery to remove the tumor is also the main treatment for soft tissue sarcomas. Depending on where in the body the sarcoma is, vital nerves and blood vessels could be at risk. The sarcoma team works closely with vascular surgeons and neurosurgeons, depending on the needs of each case, to bring focused surgical expertise into the operating room.

Once a soft tissue sarcoma is removed, our team continues to collaborate with specialists across the cancer center to address the effects of the cancer surgery. By partnering with plastic surgery colleagues, the sarcoma team can reduce risks of infection, lymphedema and repeat operations. We also recognize that cosmetic outcomes and daily function are important to quality of life after cancer, and this collaboration with plastic surgery supports our goal to save limbs, when possible, and optimize outcomes. 

Systemic therapies may include, but are not limited to, chemotherapy, immunotherapy, and targeted therapies. Medical oncologists oversee these therapies. Medical oncologists are internal medicine doctors who have completed additional training to treat cancer and sarcoma.

Chemotherapy might be given before surgery, to shrink the tumor, or after surgery, to kill any remaining microscopic cancer cells.

Immunotherapy harnesses the body’s immune system and helps it to home in on cancer cells.

Targeted therapies are more precise than chemotherapy. They’re designed to hit a specific target, like a protein that appears only on the surface of certain cancer cells. Because they’re so focused, though, they don’t work for every type of sarcoma. Researchers are working every day to identify new unique targets and to design targeted therapies for them.

Different chemotherapies, immunotherapies, and targeted therapies are approved for different sarcomas. The medical oncologists on our sarcoma team have a special focus on sarcoma. This ensures they can stay up to date on advancements in the field, the latest evidence-based treatments, and clinical trial options, both locally and across the country.  They are committed to offering new therapies as they become available.

Radiation is a key part of many sarcoma treatment plans. It can be used to kill cancer cells and shrink tumors before surgery. This improves the chances of a successful surgery and reduces the risk that the sarcoma might return. At Hollings, our experienced teams consist of specialists who map out the treatment area with the latest precision tools so that radiation can be delivered to the cancer cells while avoiding healthy tissue.

Radiation therapy can also be used for symptom relief when the cancer has weakened the bone or spread to soft tissues and is causing pain. 

Clinical trials help us identify better treatments. A clinical trial might test whether a treatment is more effective or has fewer side effects than existing treatments. It might test whether there are biomarkers that could help doctors to better match treatments to specific patients. It could test whether a different dosage or a different treatment schedule could be just as effective while requiring fewer visits to the doctor.

Clinical trials are especially important for people with rare cancers like sarcoma. Sometimes, they can offer a chance for a promising treatment option before it’s widely available.

Talk to your doctor about whether a clinical trial might be right for you. Learn more about clinical trials at Hollings and view our current sarcoma trials.

Because sarcomas are rare, health professionals specializing in sarcoma treatment are always seeking to better understand sarcoma behavior and to discover new treatments. At Hollings, we understand how important research is in understanding sarcoma and developing effective treatments.

Some recent projects include:

• Investigating safer, less toxic combination therapies for Ewing sarcomas that effectively destroy the tumors while sparing healthy tissues.
• Determining whether new combinations of already-approved drugs could reduce the viability of Ewing sarcoma cells.
• Testing the feasibility of a shorter course of preoperative radiation therapy for sarcoma patients.

Most cancers are not caused by inherited genetic conditions. But there are a number of genetic conditions that can increase the risk for either soft tissue sarcoma or bone sarcoma. Some of these include Li-Fraumeni syndrome, Werner syndrome, Diamond-Blackfan anemia and Rothmund-Thomson syndrome.

Both the Hollings Hereditary Cancer Clinic and the Division of Medical Genetics and Genomics at MUSC Children’s Health offer evaluation, support and care for people with genetic conditions.

Our sarcoma specialists work closely with the pediatric oncologists at MUSC Children’s Health. MUSC Children’s Health has been ranked No. 33 in the nation for pediatric cancer care by U.S. News and World Report, and MUSC Shawn Jenkins Children’s Hospital features a floor that is entirely dedicated to cancer care. Children go to this floor for both inpatient and outpatient care, creating continuity during a stressful time. Child life specialists, a clinical psychologist who focuses on children with cancer, and a dedicated therapy dog are also part of the team.