Introduction to Sarcoma Treatment
Excerpts from an ESUN article
It is critical that patients and caregivers alike understand that there is no "quick fix" with regards to treatment of sarcoma. The process of evaluation, diagnosis, treatment and follow up is long and arduous, and requires a significant commitment from all involved.
By the time the patient presents to the appropriate specialists, a great deal of stress has already occurred, and is magnified when the diagnosis of cancer is made. Often the patient’s wish is to have the tumor removed as soon as possible in an effort to "get the cancer out". While this sentiment is understandable, with sarcoma, surgery usually follows after an even longer period of time for the administration of preoperative adjutants such as chemotherapy and radiation.
Though many variations exist between cancer centers in the approach to these diseases, typically some form of adjuvant therapy, such as radiation and/or chemotherapy, accompanies surgical care for sarcomas.
Treatment of bone sarcomas in most centers involves up to 3 months of chemotherapy prior to surgery (neoadjuvant or induction chemotherapy), with completion of the course after an appropriate period of recovery from surgery has occurred. In all, this process can take up to a year, assuming no other complications or need for further procedures occur.
With regards to soft tissue sarcomas, typically a course of radiation therapy (often about 5 weeks’ worth) with or without chemotherapy preceeds surgical resection. While the decision to give radiation before, after or before and after surgery remains somewhat controversial (or may change on a case-by-case basis), it is certainly an integral part of the treatment plan for these tumors. Logistically, it adds a component of complexity for the patient, requiring daily treatments for about 5 weeks.
Given the length and complexity of treatment for bone and soft tissue sarcomas, it is no wonder that patients often become disillusioned and frequently depressed during the process. It is important for patients and their families to understand that this is a very normal and natural response. Commonly, centers where sarcoma patients are treated have resources and/or personnel available to help patients and their families cope with such accompanying psychological difficulties.
For more information, see the ESUN articles about dealing with the side effects of sarcoma treatment and coping with sarcoma.
Once the course of treatment has been completed, a necessary schedule of follow up begins. Usually, this means visits with some type of imaging and/or other ancillary testing (cardiac testing, laboratory exams, etc.) every three months for 2-3 years, every 6 months until 5 years after treatment, then annually. Many permutations of this certainly exist, and schedules are often varied for a particular patient, predicated on many potential factors, most frequently the presence of metastasis (disease spread).
As opposed to most types of carcinoma, there is really no time when "cure" is felt to have been definitively achieved. Sarcoma is a lifelong diagnosis, and should be treated as such. Having said this, most recurrences or metastases will be discovered within the first two to five years after treatment. Once the patient has cleared the five-year mark, the risk of recurrence diminishes greatly, but still certainly exists.
With current treatment protocols, many more are surviving sarcomas than ever before, and research is ongoing. Prognoses continue to improve. With these advances and the relatively long lifespan of many of these patients, the importance of long-term follow up and recognition of distant treatment sequelae becomes even greater.
Treatment Protocols
The National Comprehensive Cancer Network provides treatment guidelines related to sarcomas. To access these guidelines, register for a free account at NCCN, and then login. Then click on any of the links below:
- Practice Guidelines for Bone Cancer
- Practice Guidelines for Soft Tissue Sarcomas
- Practice Guidelines for Dermatofibrosarcoma Protuberans
- Optimal Management of Patients with Gastrointestinal Stromal Tumor (GIST)
- Practice Guidelines for Uterine Neoplasms
The following practice guidelines may also be useful for sarcoma patients, caregivers and practitioners (access also requires login mentioned above):
- Adult Cancer Pain
- Cancer- and Chemotherapy-Induced Anemia
- Cancer-Related Fatigue
- Distress Management
- Palliative Care
- Pediatric Cancer Pain
- Prevention and Treatment of Cancer-Related Infections
- Senior Adult Oncology
About the National Comprehensive Cancer Network (NCCN)
The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 21 of the world’s leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives.
World-renowned experts from NCCN Member Institutions diagnose and treat patients with a broad spectrum of cancers and are recognized for dealing with complex, aggressive, or rare cancers. More than 160,000 new patients receive cancer care at NCCN Member Institutions over the course of any year. NCCN Member Institutions pioneered the concept of the multidisciplinary team approach to patient care and lead the fight against cancer as they integrate programs in patient care, research, and education. Our programs offer access to expert physicians, superior treatment, and quality and safety initiatives that continuously improve the effectiveness and efficiency of cancer care. Thirty-seven Nobel Prize winners have served on the faculties of NCCN Member Institutions. [From the NCCN Website]
BC Cancer Agency Chemotherapy Protocols
The British Columbia Cancer Agency’s listing of chemotherapy protocols for Sarcoma treatment. Each listed protocol gives detailed information regarding eligibility and testing for that protocol, dosing levels for pre-medications and chemotherapy agents, and dose modifications for various toxicities.
European Society for Medical Oncology (ESMO) Clinical Practice Guidelines
The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each CPG includes information on the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans and follow-up.
Article Excerpts Copyright © 2005 Liddy Shriver Sarcoma Initiative