When treating sarcomas, experience matters. At Penn Medicine, we have a deep understanding of even the rarest sarcomas. We follow national guidelines, while also incorporating our own experience and the latest findings on new treatments.
Whether you have a slow-growing sarcoma or an aggressive tumor that has metastasized (spread) or recurred (come back), our team can help.
Our Approach to Sarcoma Treatment
Many sarcomas need several types of therapy for effective care. People with these tumors benefit most from a multidisciplinary team working together on treatment recommendations. Each week, we bring our sarcoma cases before a tumor board, a meeting where a wide range of Penn sarcoma specialists contribute their expertise and experience to determine the best care for each individual patient.
Our approach to sarcoma care follows some key principles:
- Making an accurate, timely sarcoma diagnosis
- Creating individualized treatment plans based on your goals and preferences
- Bringing together our full team for comprehensive expertise
- Performing the right kind of surgical removal the first time and setting the stage for full recovery
- Providing other needed therapies such as radiation, chemotherapy, or immunotherapy, including the consideration of clinical trials
- Offering full support throughout care for you and your family
- Encouraging follow-up visits for up to 5 to 10 years after treatment, to catch any potential cancer recurrences
Surgery for Sarcoma
We remove sarcomas with the goal of taking them out in one piece while preserving the healthy tissue around them. This special approach, which is not required for most other cancer types, helps reduce the chance that the sarcoma returns in the same location and that you maintain the highest level of function and mobility possible.
Learn more about sarcoma surgery.
Radiation Therapy for Sarcoma
Radiation therapy is most commonly used in coordination with surgical treatment to treat soft tissue sarcomas. This approach helps to prevent the tumor from recurring in the same location. Infrequently, radiation may be used without surgery at a higher dose.
Our radiation oncologists provide a range of treatments:
Radiation for Soft Tissue Sarcoma Treatment to Avoid Recurrence
Large, high-grade soft tissue sarcomas in the arms, legs, pelvis, and spine tend to recur (come back) if surgery is the only treatment. Radiation therapy is critical to help prevent that cancer recurrence.
While some programs use radiation to treat patients with soft tissue sarcoma after surgery, we do it before (called neoadjuvant treatment), when needed. This approach prevents cancer from returning just as effectively, but uses a smaller radiation dose and lowers the chances of long-term side effects such as fibrosis (scarring) of the tissues.
Whenever possible, we work to get insurance approval for a form of treatment called intensity-modulated radiation therapy (IMRT). It’s less harmful to healthy tissues and bones compared to older techniques because it can be tightly controlled to match a tumor’s unique shape and size.
Proton Therapy
Proton therapy is a form of radiation therapy that uses a different form of energy than other radiation therapies. Proton beam radiation travels into the body, deposits a full dose of radiation at the tumor and then stops. Other forms of radiation continue past the tumor, exposing nearby healthy tissue to radiation. Proton therapy beams can also be tightly mapped to match tumor shape.
Proton therapy has not shown a benefit for most sarcomas in adults compared to IMRT. We use it in certain situations to help spare healthy tissue near particular tumors:
- Chordomas at the base of the skull or lower spine
- Sarcomas in the heart’s muscles or blood vessels, to protect the lungs, esophagus, and healthy heart tissue
- Children with sarcomas, to protect surrounding tissues and reduce the risk of radiation-caused cancers later
- Cancer that returns in patients who have previously received other types of radiation therapy
Stereotactic Body Radiation Therapy (SBRT) and Stereotactic Radiosurgery (SRS)
These techniques use a narrower beam than other forms of radiation therapy to deliver highly precise, concentrated doses. We use them to treat metastatic sarcomas in the lungs, brain, and spine.
Radiation as an Alternative to Surgery
For sarcomas that cannot be removed with surgery, radiation therapy may be a potential treatment option because it may shrink tumors and control cancer growth for a variable period of time.
Our team may recommend radiation therapy as a reasonable alternative to surgery for Ewing sarcoma in areas where surgery is not possible or when it would cause too much damage. While radiation therapy is commonly used in combination with surgery for chordomas on the spine or at the bottom of the skull, it can be used without surgery, although this is rare.
Chemotherapy for Sarcoma
In certain cases, chemotherapy can be used along with sarcoma surgery to reduce the chance that cancer spreads to the lungs or elsewhere in the body.
Doctors may recommend chemotherapy before or after surgery for certain soft tissue sarcomas:
- Pediatric rhabdomyosarcoma
- High-grade soft tissue sarcomas in the arms and legs that have advanced into nearby lymph nodes or other parts of the body
- Certain liposarcomas—high grade myxoid round cell liposarcoma
- Ewing sarcoma when it forms in soft tissues
Bone sarcomas such as Ewing sarcoma and osteosarcoma nearly always require chemotherapy both before and after surgery.
Treating Returning Sarcoma and Stage IV Sarcoma
If sarcoma spreads or returns after surgery, our team may recommend a second surgery depending on where and how large the tumor is. When surgery isn’t appropriate, other options may be available.
For sarcomas that have spread from their initial site, we often prescribe drug therapy, with our medical oncologists providing a range of treatments. Our team offers the latest options and continues to help develop new therapies.
Drug therapy for metastasized or recurrent sarcoma includes:
- Chemotherapy: We may give a single drug or a combination, depending on the type of sarcoma.
- Epigenetic therapy: These leading-edge drugs affect critical genes involved in tumor control. The first approved therapy, tazemetostat, treats epithelioid sarcoma.
- Immunotherapy: Another newer approach, these drugs work with the immune system to treat cancer. We have immunotherapy options for angiosarcoma, myxofibrosarcoma, undifferentiated pleomorphic sarcoma (UPS), and a form of liposarcoma called dedifferentiated liposarcoma. Our program and others are regularly developing drugs for additional sarcoma subtypes.
- Targeted therapy: Some newer drugs target the ways sarcomas grow and spread. We may genetically sequence sarcomas to look for genetic changes that respond to certain drugs.
Clinical Trials of New Sarcoma Treatments
At Penn Medicine, we are committed to developing the latest treatment options for sarcoma care. We consistently offer a robust selection of promising clinical trials, and we are always looking to add more. Our team always considers clinical trial treatments when tumors return or spread.
Trials may focus on a specific sarcoma, a group of sarcomas, or a range of cancers that includes some sarcomas. Recent investigations have studied:
- Targeted therapy aimed at different pathways than previous drugs
- Combining existing immunotherapy with radiation therapy, to boost immune response
- Combining multiple categories of drugs
- Developing new types of immunotherapy
- Exploring epigenetic therapy and therapy aimed at cell metabolism (energy use)
Learn more about our current sarcoma clinical trials
Make an Appointment
Please call 800-789-7366 or make an appointment.
The Penn Sarcoma Program offers same-day appointments to patients who have their imaging available. To learn more, call 215-349-8200.