Treatment for Sarcoma

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

Sarcoma treatment at Fred Hutch is customized for each patient’s needs.

How Do We Create Your Treatment Plan?

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:

  • Consider the standard therapy for your subtype
  • Find out if any clinical trials match your needs, so you can think about joining them

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.  

Why Do Treatment Plans Differ?

The treatment plan we make for you depends on many things, including:

  • Your type of sarcoma — either soft tissue or bone cancer
  • Your subtype of sarcoma
  • The grade of your tumor, either low-grade or high-grade
  • The stage of your disease
  • If you have had treatment for sarcoma in the past
  • Your age and overall health
  • Your needs and preferences, like what type of treatment schedule works in your life and if you want to join a clinical trial

What Is The Standard Therapy for Sarcoma?

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.

Treatment Process

Different subtypes of sarcoma start, progress and respond to treatments in different ways. We choose, combine and schedule your treatments based on what works for your subtype. Your care team makes sure you understand each type of treatment and all of your choices.


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:

  • The details of your procedure
  • The benefits and risks
  • How to get ready for surgery
  • What to expect during your recovery and beyond

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

Proton Therapy

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:

  • The tumor is close to critical organs
  • The patient is trying to save their fertility so they can have children
  • A patient has had radiation before
  • The disease is recurrent, and radiation is needed several times over many years

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 External-Beam Radiation Therapy (EBRT)

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. 

Intraoperative Radiation Therapy (IORT)

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. 

Fast Neutron Therapy

Neutron therapy attacks cancer cells with neutrons. There are two advantages to using neutrons instead of photons or electrons: 

  • Neutron beams are much more powerful. They deposit about 20 to 100 times more energy into the target tissue than photons or electrons can. 
  • Neutron beams are more likely to damage both strands of a cancer cell’s DNA, rather than only one strand. This makes it harder for the cells to repair themselves and survive. 

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.

Learn More About Chemotherapy

Targeted Therapy and Immunotherapy

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.

Learn More About Immunotherapy

Radiation Therapy

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.

Learn More About Radiation Therapy

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

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:

  • Surgery to remove all the cancer the surgeons can see
  • Chemotherapy, in liquid form, that is warmed up and then put into your abdomen to kill any cancer cells that are left behind after surgery
Learn More About CRS-HIPEC

Monitoring Your Health

While you are in active treatment, your sarcoma care team will see you regularly for exams and tests to check:

  • How well your treatment is working
  • If there is any reason to change your treatment
  • If you need help with side effects or supportive care services, like nutrition care or mental health counseling

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.

Managing Side Effects

You may be wondering about possible side effects from treatment, like hair loss or nausea from chemotherapy. If you are, it might be helpful to know that many of today’s treatments are more targeted to cancer cells, so they don’t cause as many side effects as standard chemotherapy. 

You are always at the center of everything we do. Sarcoma doctors, nurses and advanced practice providers are here to help prevent or help with side effects of treatment. 

Get Help with Side Effects

Before you begin treatment, we will talk with you about what to expect, based on your treatment plan, and what can help if you do have side effects.
At your appointments, we want you to tell us about any side effects you are having. If you have questions or concerns between appointments, you can call or email us. We will make sure you know how to reach care providers at Fred Hutch after hours, if that is when you need us. 

We have many tools to help you feel better, such as:

  • Antibiotics, vaccines and antiviral drugs to prevent or treat infections
  • Transfusions, steroids and medicines that help the immune system treat low levels of blood cells (low blood counts)
  • Nutrition care and medicines to help with digestive problems
  • Conventional and integrative therapies for pain

Coping with Side Effects

Caregiving During Treatment

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:

  • Keeping track of their appointments and driving them to and from treatment
  • Watching for changes in their condition and telling their care team about any symptoms
  • Providing physical care, like helping them take medicines
  • Spending time with them and encouraging them
  • Taking care of things at home that they may not be able to do, like grocery shopping and cleaning

Supportive Care Services

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

Continuing 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).

Schedule for Follow-Up Visits

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:

  • Your sarcoma type and subtype
  • Which treatments you had and how your disease responded 
  • How the disease and treatments affected you 
  • How long it has been since your treatment ended

Our Sarcoma Surveillance Clinic offers monitoring for patients who are done with their sarcoma treatment. 

Meet the Sarcoma Care Team