Sarcoma is often hard to treat, so it’s important to receive care at a specialized center with sarcoma expertise. At Fred Hutchinson Cancer Center, our experts offer multidisciplinary, team-based soft tissue sarcoma treatment as well as bone cancer treatment, including advanced therapies and new options that are only available through clinical trials.
Treatment Plan | Treatment Process | Monitoring Your Health | Supportive Care Services | Continuing Care
Sarcoma treatment at Fred Hutch is customized for each patient’s needs.
Your Fred Hutch physician works together with a group of other sarcoma specialists. They include medical oncologists, radiation oncologists, surgeons and researchers who are looking for better ways to treat this disease.
Every week, this team goes to a meeting called a tumor board. Together, dozens of team members discuss their patients’ treatment plans. This approach means each patient benefits from the experience of the whole group.
With support from the larger team, your physician will:
Your physician will walk you and your caregiver through the treatment plan that the tumor board has recommended for you. You will have a chance to share your personal preferences and options, and you will decide together what happens next.
The treatment plan we make for you depends on many things, including:
Because there are more than 70 subtypes of sarcoma — depending on the nearby tissue, the affected area of the bone or the type of cells creating the tumor — there is no one way to treat everyone.
However, many people have a combination of chemotherapy, radiation therapy, proton therapy, surgery and targeted therapy (also called immunotherapy). Sometimes, surgery is the only treatment that a person needs.
At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy.
You may also choose to have new sarcoma therapies that you can get only through a clinical trial. Many people come to Fred Hutch for access to these studies. Your care team will tell you about studies that might be right for you, so you can think about joining them.
Surgery is the most common treatment for sarcoma, and it may be curative for some people. Chemotherapy, radiation therapy or both may be given before or after surgery to reduce the risk of the cancer coming back.
Our sarcoma patients have their surgeries done by UW Medicine surgeons who provide care at both Fred Hutch and UW Medical Center – Montlake.
We offer the latest surgical options, including limb-sparing surgery, bone transplants and metallic implants, if you need them. We use minimally invasive techniques, such as laparoscopic surgery (through small "keyhole" incisions), as much as possible.
The exact surgery you need will depend on many things, including the location and size of your tumor. Your team will explain:
During surgery, intraoperative ultrasound helps our surgeons see the borders of your tumor more clearly, so they can remove the whole tumor while saving healthy structures nearby. After your surgery, your care team follows evidence-based guidelines to improve your recovery.
Sometimes, a tumor cannot be removed with surgery because of its size or location or how aggressive it is. In these cases, we’ll find another course of treatment to control the sarcoma, shrink it and help with pain and other symptoms.
Learn more about Surgery
For some subtypes of sarcoma, proton therapy can save healthy tissue and reduce exposure to radiation.
Proton therapy is a helpful treatment option in cases where getting the smallest amount of radiation exposure is especially important, such as when:
Since proton therapy is only appropriate for specific subtypes of sarcoma, your care team will let you know if it is an option for your treatment plan.
Learn more about Proton Therapy
Conventional EBRT uses a machine called a linear accelerator to send beams of high-energy X-rays (photons) at the cancer. Usually, EBRT is given five days a week (Monday through Friday) for several weeks. The procedure doesn’t hurt, and each treatment takes only a few minutes.
There are several forms of EBRT. Your radiation oncologist will decide the form that’s right for your tumors, set the dosage and schedule for your treatments and help you manage any side effects.
IORT is a fast, effective and exact form of radiation that is used during surgery to treat tumors. It may be used to treat tumors that came into contact with the tumor during surgery.
IORT takes just a few minutes and uses only a fraction of the total radiation given over a traditional multi-week course of EBRT. UWMC is the only hospital in our five-state region — Washington, Wyoming, Alaska, Montana and Idaho — to offer this treatment.
Neutron therapy attacks cancer cells with neutrons. There are two advantages to using neutrons instead of photons or electrons:
UW Medical Center - Montlake is the only place in the U.S. to offer neutron therapy, and the physcians here are internationally known as experts in neutron therapy. We sometimes use neutron therapy to treat sarcomas when we believe this may work better than conventional forms of radiation therapy.
Chemotherapy is a major and important part of sarcoma care. It may be given before or after surgery or when complete surgical removal would be difficult.
Depending on what your physician recommends, you may get chemotherapy before or after sarcoma surgery to reduce the risk of the cancer coming back or to make sure the tumor is completely gone. Chemotherapy may also be used to shrink your tumor and help with pain and other symptoms.
Many chemotherapy medicines are given through an intravenous (IV) line in repeating cycles. There are also chemotherapy treatments for sarcoma given in tablet form.
Your Fred Hutch team will talk with you about which medicines we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout Fred Hutch.
Targeted therapies are another type of medicine that can be used in sarcoma treatment. These therapies look for a gene or protein that is responsible for allowing cancer to grow — and they damage any cancer cells they find. Or they prompt your immune system to attack particular cells (also called immunotherapy).
Targeted therapy and immunotherapy for sarcoma can be used on both soft tissue sarcoma and bone cancer. Often, olaratumab and pazopanib are used for soft tissue sarcoma, and denosumab is used for bone cancer.
Because there are many types of sarcoma, there are targeted therapies designed for different types, such as sorafenib for desmoid tumors and imatinib, sunitinib, regorafenib and pazopanib for gastrointestinal stromal tumors.
Fred Hutch has one of the largest sarcoma immunotherapy research programs anywhere, which means there may be immunotherapy clinical trials you can join.
Radiation therapy may be used before or after surgery to reduce the risk of your sarcoma coming back. It may also be used to shrink your tumor and help with pain.
Radiation therapy is an important treatment for many types of sarcoma. Depending on your treatment plan, it may be used before or after surgery, to control the tumor if surgical removal is not an option or to shrink the tumor to reduce pain and other symptoms.
We use studies to test different combinations of radiation therapy and immunotherapy to find out what works best. We are always looking for new ways to make immunotherapy more effective and boost the body's immune response against cancer.
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC) may be able to control advanced disease while also giving you a good quality of life. Our experienced CRS-HIPEC team combines two parts into one operation:
While you are in active treatment, your sarcoma care team will see you regularly for exams and tests to check:
We update your treatment plan based on the best scientific evidence as well as how your disease responds and what you prefer.
What about “cured”? Sometimes physicians use the word “cured” if you have been in complete remission for at least five years. After 10 years, cancer is less likely to come back (recur), but recurrence is still possible.
If the person you are caring for is having surgery or getting treatments like chemotherapy, targeted therapy, immunotherapy, proton therapy or radiation therapy, there are many ways you can help. Caregiving often means doing tasks like these:
Along with treating your sarcoma, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.
From registered dietitians to chaplains, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need.
Learn more about Supportive Care
When your disease is in remission and your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see the same Fred Hutch team who treated your sarcoma. They will check your overall health and look for signs that your cancer has come back (signs of recurrence).
Your team will also help with any long-term side effects (which go on after treatment ends) or late effects (which may start after treatment is over).
Just like we personalize your treatment plan for you, we personalize your follow-up schedule, too. Your provider will base your schedule on many things, including:
Our Sarcoma Surveillance Clinic offers monitoring for patients who are done with their sarcoma treatment.