How do doctors treat soft tissue sarcoma?

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Surgery is the best option for curing STS, so doctors usually include this in the treatment plan if possible.

Other factors doctors consider when choosing treatment options include:

• the type of STS
• tumor grade, size, and stage
• tumor location
• whether surgery can remove all of the tumor
• if the cancer is new or recurring
• the age and overall health of the person

Does the cancer stage influence treatment?

For most types of STS and for earlier stages of sarcoma, the treatment is usually similar. People may have surgery alone, or radiation therapy or chemotherapy in addition to surgery.

Treatment may include targeted therapy and immunotherapy drugs for specific types of advanced STS.

Learn more about sarcoma here.

A team of doctors may treat soft tissue sarcoma. This team can include:

• Orthopedic surgeon: This surgeon specializes in bone, muscle, and joint diseases. They may work with people who have sarcomas in the arms or legs.
• Surgical oncologist: This surgeon treats cancer, focusing on sarcomas in the abdominal area.
• Medical oncologist: This doctor specializes in treating cancer with drugs, such as chemotherapy.
• Radiation oncologist: This doctor specializes in treating cancer with radiation therapy.
• Thoracic surgeon: This surgeon treats diseases of the chest and lungs and focuses on sarcomas in the chest area.
• Physiatrist: This rehabilitation doctor specializes in treating conditions that affect movement.

According to the American Cancer Society, research has shown that treatment at cancer centers specializing in sarcomas may result in better outcomes.

Soft tissue sarcomas can be difficult to treat, so working with a team of healthcare professionals with experience and expertise in sarcoma treatment is essential.

Learn about soft tissue sarcoma outlook here.

Surgery aims to remove the tumor and 1–2 centimeters (cm) of surrounding tissue to ensure no cancer cells remain.

It is the most common method of treating STS. For small, low-grade tumors, particularly those in the arms, legs, or torso, surgery may be the only treatment people require.

Surgery may include the following procedures:

• Mohs micrographic surgery: A surgeon cuts away the tumor in thin layers, removing a layer at a time until a microscope cannot detect any more cancer cells.
• Wide local excision: A surgeon removes the tumor and some surrounding, normal tissue.
• Limb-sparing surgery: This type of surgery removes a tumor in an arm or leg without the need for amputation. People may first have chemotherapy or radiation therapy to shrink the tumor.
• Lymph node dissection: This is surgery to remove any lymph nodes that may be cancerous.
• Amputation: In rare cases, surgeons remove an arm or leg to treat STS.

Doctors usually recommend radiation therapy after surgery to destroy any remaining cancer cells. In some cases, people may have radiation therapy before surgery to shrink a tumor that is large or difficult to remove.

A person may also have radiation therapy as the main treatment option if surgery is unsuitable. Types of radiation therapy for STS include:

• External beam radiation: People may have external beam radiation daily over several weeks — it is the most common type of radiation therapy for sarcomas. Intensity-modulated radiation therapy is a technique that reduces damage to normal tissue as much as possible.
• Intraoperative radiation therapy: People receive a large dose of radiation straight after surgery, which means the radiation does not pass through healthy tissue.
• Internal radiation therapy: During surgery, a surgeon places small pellets of radioactive material near the STS.

Learn about types of radiation therapy here.

Immunotherapy drugs help support the immune system to destroy cancer cells.

Certain proteins, known as checkpoint proteins, can sometimes prevent the body from destroying cancer cells. Immune checkpoint inhibitors help to block certain checkpoint proteins to help the immune system destroy cancer cells.

Checkpoint inhibitors for STS include PD-1 and PD-L1 inhibitors, which people take intravenously.

PD-1 inhibitors include pembrolizumab (Keytruda). This may be a treatment option for advanced STS. PD-L1 inhibitors, such as atezolizumab (Tecentriq), may help treat alveolar soft-part sarcoma.

People may have intravenous chemotherapy to treat STS. Chemotherapy drugs target the whole body, so doctors may recommend it for sarcomas that have spread.

Chemotherapy can be the main treatment or an additional treatment to surgery, depending on the stage and type of STS.

Chemotherapy drugs for treating sarcoma include:

• ifosfamide (Ifex)
• doxorubicin (Adriamycin)
• dacarbazine (DTIC)

Learn how long chemotherapy takes here.

Targeted drug therapy is a treatment that targets cancer cells specifically, causing less damage to healthy cells than radiation therapy or chemotherapy.

People usually take targeted therapies to treat STS orally. They include tyrosine kinase inhibitors and histone methyltransferase inhibitors.

Tyrosine kinase inhibitors help prevent cancer cells from growing and dividing. Examples include pazopanib, imatinib, regorafenib, and sunitinib.

Histone methyltransferase inhibitors, which help prevent cancer cells from growing, include tazemetostat.

Complementary therapies are treatments people may have in addition to medical treatments for STS. Complementary therapies include:

• acupuncture
• acupressure
• tai chi
• yoga
• massage therapy
• meditation
• aromatherapy
• art therapy
• music therapy
• biofeedback
• spirituality and prayer

People must discuss complementary therapies with their healthcare team before trying them alongside medical care.

Surgery is the most common treatment for soft tissue sarcoma. If surgery cannot remove a tumor completely, people may also have chemotherapy or radiation therapy.

A person can have targeted therapy or immunotherapy for certain types of sarcomas or those in the more advanced stages.

Various complementary therapies may help reduce treatment side effects. People should first discuss these with a doctor.