More Options, Better Outcomes
Dr. Kane discusses the intricate process of diagnosing and treating a rare cancer like soft tissue sarcoma.
Sarcoma treatment at Roswell Park includes conservative limb-sparing surgical techniques combined with radiation therapy and/or chemotherapy, plus regional therapies to achieve the best possible outcomes while avoiding amputation.
When your case is discussed at the multidisciplinary team meeting, the sarcoma team will assess and plan the best treatment strategy for you. For many sarcoma patients, their individualized plan will include one or more of the following therapies:
Our surgeons perform the latest minimally invasive surgical techniques to remove sarcoma tumors while operating near critical nerves and blood vessels, sparing limbs and preserving patients’ function and quality of life. Our surgeons avoid limb amputation whenever possible.
Years ago, amputation for sarcoma was a given. But we found that less radical surgery plus radiation could yield the same outcomes in terms of cancer control, and was much better for the patient to keep their limb rather than lose it. - John Kane, III, MD, Chief of Sarcoma/Melanoma Surgical Oncology
RPCI surgeons perform the following techniques for surgical treatment of sarcoma.
- Wide local excision: Surgery to remove the cancer along with some surrounding healthy tissue, leaving the margins (bordering tissue) free from cancer.
- Limb-sparing surgery: Removing the cancer from an arm or leg, while avoiding amputation.
- Lymphadenectomy: Surgery to remove one or more lymph nodes in the tumor area. Nodes are then examined for cancer.
- Amputation: Surgery to remove all or part of a limb.
- Plastic and reconstructive surgery: Surgery to restore or improve the appearance and/or function of body structures.
Also called radiotherapy, this treatment directs high-energy radiation at the cancer cells to kill them or to keep them from growing. Your sarcoma treatment plan may include radiation therapy in combination with surgery and your radiation treatments may be conducted before, during, and/or after surgery.
- Pre-operative radiation: Sarcoma tumors tend to have “roots and fingers” that grow into surrounding tissue. Radiation is often used to target a border or margin of this surrounding tissue before the surgery to remove the tumor. This may help your surgery be less drastic and more successful, with better chance for the surgeon to achieve “clear margins,” or cancer-free areas surrounding where the tumor used to be.
- Intra-Operative Radiation Therapy (IORT): Roswell Park is the only facility in the state outside of New York City with the capabilities to deliver radiation therapy internally during surgery. This approach also helps improve ability to get clear margins. Patients who have had previous external beam radiation may still have Intra-Operative Radiation Therapy.
CS/HIPEC is a unique treatment at Roswell Park. Learn more from Dr. Kane.
This approach uses drugs to attack cancer cells, interrupting how they divide and multiply in order to prevent a tumor from growing. This treatment type may be given before and/or after surgery.
- Systemic chemotherapy: Given intravenously (IV) or taken orally, the drugs circulate the body, seeking rapidly-dividing cancer cells to destroy.
- Regional chemotherapy: These newer techniques involve surgery to remove as much tumor as possible (called cytoreduction) and then the anti-cancer drugs are placed directly into the cerebrospinal fluid, affected organ, limb or abdominal cavity. This allows oncologists to administer a higher dose of chemotherapy directly to the tumor, killing cancer cells more effectively while limiting the drugs’ effect on the rest of the body.
Roswell Park is the only care center in Western New York that performs these regional chemotherapy treatments:
- Isolated Limb Perfusion (also called Isolated Arterial Perfusion): Chemotherapy drugs are placed directly into the blood vessels that supply the limb where the sarcoma tumor is located. Blood flow to and from the limb is temporarily halted to keep the treatment at the tumor site.
- Cytoreductive Surgery /Hyperthermic Intraperitoneal Chemoperfusion (CS/HIPEC): This approach may be used to treat cancer that has spread in the abdomen. After surgery to remove all visible tumors, the oncologist bathes the abdominal cavity with heated chemotherapy drugs. Because the drugs are restricted to the abdomen, with little absorbed into the bloodstream, higher doses may be used to kill cancer cells. RPCI also uses this treatment approach for some cases of mesothelioma and recurrent ovarian cancer.
The need for new and better sarcoma treatment remains urgent. Through RPCI’s robust research program, the sarcoma team can offer patients access to treatments they would not have through other cancer care providers. Some of our current work includes:
- The development of new drugs for sarcoma.
- Finding new ways to use existing cancer drugs or therapies.
- The discovery of new targets or pathways to attack the cancer.
RPCI Clinical Research Center: This center is one of the first in the nation that focuses specifically on the development of new cancer treatments. Housed in the RPCI hospital, the center can offer patients more treatment options and provide the highest level of patient safety.