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Why should you receive treatment for
bone and soft tissue sarcoma in AMC?

A bone and soft tissue sarcoma is an uncommon tumor that accounts for 1% of all adult cancers. Despite its low incidence, this disease has more than 500 kinds of various histological subtypes. Even though bone and soft tissue sarcomas rarely occur, due to their broad range of types and different characteristics, it is difficult to make an accurate diagnosis. Also, because the tumors do not show a consistent response to surgery, chemotherapy, and radiotherapy, predicting the results of the treatment is challenging. Moreover, depending on the location of the tumor, the patient’s age, and the general conditions of the tumor, a different treatment method may need to be applied.

Because bone and soft tissue sarcomas tend to occur in all parts of the body, it is hard to obtain basic statistical data regarding their incidence or survival rates. For effective treatment, accurate diagnosis along with the combined use of surgery, chemotherapy, and radiotherapy are needed.

AMC’s Bone & Soft Tissue Sarcoma Center has a collaboration system that allows highly experienced specialists of the departments of orthopedic surgery, oncology, radiation oncology, pathology, and radiology to gather and discuss the best treatment option for each patient. Patients who receive such specialized treatment would have a better understanding of their treatment process, thus increasing patient satisfaction. Recently, a growing number of patients who were diagnosed in other hospitals have visited AMC for treatment.

Treatment options

Standard Treatment

Chemotherapy is initiated when the bone and soft tissue sarcoma has progressed beyond the point of surgery. Unfortunately, soft tissue sarcomas are not a single disease entity. They entail all malignant tumors that originate from the soft tissues of various bodily structures. Furthermore, the incidence rate of a single manifesting soft tissue sarcoma is very low, making standardized treatment for each histological type extremely difficult. At the moment, treatments available involve the sole or combined use of surgical resections, radiotherapy, and chemotherapy (drug therapy).

Surgical Options

If possible, the first line of treatment is the radical resection of the sarcoma and the surrounding healthy tissues. During surgery, the tumor including the original biopsy site is removed as a whole. If the first surgery did not adequately resect the tumor, microscopic tumor cells invisible to the naked eye may remain in the resected margins, requiring a subsequent radical resection. If the sarcoma had invaded the surrounding lymph nodes, lymph node dissection would be done simultaneously. There are cases in which amputation may be inevitable to successfully get rid of the tumors, especially in tumors involving the legs and arms. Some examples of these cases are: The tumor invades the major nerves or blood vessels. It is impossible to recover the function of the defective part after tumor removal. The area around the tumor is infected. Untreatable complications occur after limb-sparing surgery. A pathologic fracture occurs. There is no benefit from limb-sparing surgery compared to the prosthetic leg due to leg length differences in the future.

Limb-sparing surgery, rather than amputation, is possible if the tumor can be resected successfully. However limb-sparing surgery, for the purpose of conserving limb functions, should be considered carefully without having it compromise the chances for complete recovery. The possibility of tumor resection is determined by the surgeon based on the scope of the tumor, the relationship between surrounding organs, and remote metastasis.

Radiotherapy

Radiotherapy uses X-ray or high radiation to eradicate tumor cells or to reduce the size of the tumor significantly. Radiation beams are focused on a marked area of the body using extracorporeal devices.

Preoperative radiation therapy reduces the tumor to a respectable size, increasing the chances of successful resection and lowering recurrence rates. Also, postoperative radiation therapy is applied without delaying surgery, which is the primary treatment option. Surgery can help identify the exact location of the tumor, which is beneficial in locating the target site for radiation therapy, conclusively lowering local recurrence rates.

Chemotherapy

Chemotherapy is a kind of drug therapy that is regularly administered intravenously. It is a systemic treatment that targets cancer cells that have already extended beyond the affected area and have spread throughout the body. For soft tissue sarcomas, an intravenous regimen including doxorubicin is used solely or in conjunction with other anticancer agents. General chemotherapy side effects such as nausea, vomiting, hair loss, bone marrow depression, as well as cardiotoxicity (10%) leading to heart failure may occur.

Whether or not to start chemotherapy is determined by an oncologist after weighing its advantages and disadvantages and especially after considering each patient’s condition and tumor type. If patients with progressive soft tissue sarcomas have good general conditions, no liver metastasis, less-differentiated cancers, and a long time gap between diagnosis and relapse, they are likely to show favorable prognosis.