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
Sarcoma surgery
Sarcoma treatment almost always centers around removing the tumor with surgery that is often complex and requires a careful approach.
At Penn Medicine, you have access to a range of highly experienced and specialized surgeons for sarcoma removal, giving you the best chance of a cure. Our team includes top surgeons from multiple disciplines that each have a particular sarcoma focus, including orthopaedic oncologists, surgical oncologists, neurosurgeons, and plastic surgeons. These specialists work together to plan and perform tumor removals and restore areas where they have operated, while maintaining as much of your function and quality of life as possible.
Types of sarcoma surgery by area
Taking sarcomas out in one piece (known as en bloc removal or wide resection) provides the best outcome. Our surgeons perform en bloc surgery whenever possible, taking a little extra healthy tissue beyond the edges of the tumor. Following these steps greatly reduces the chance that cancer will return in the same location.
The additional surgical approaches we take depends on the location of the tumor:
Our team of orthopaedic oncologists and reconstructive surgeons is able to save limbs about 90 percent of the time, effectively removing tumors in the arms and legs while preserving function and appearance. We achieve this result even with complex and large sarcomas, which is not the case at all healthcare institutions when it comes to sarcoma surgery.
We also work to provide you with full limb function upon recovery, without pain. Ideally, we want to get you back to the function and mobility you had before your cancer diagnosis.
While our preference is always to spare limbs, there are times when we recommend amputation in order to remove the sarcoma completely, to preserve critical structures, or more effectively treat the cancer. In such cases, we will help you prepare for what to expect and provide full support to help you recover and adapt as quickly as possible.
Sarcoma removal in the retroperitoneum (the space in the back of the belly) is often complex. Surgeries frequently involve the colon, kidneys, spleen, or pancreas.
Our surgical oncologists partner with orthopaedic oncologists, neurosurgeons, vascular surgeons, and plastic surgeons for team surgeries as needed. Our team protects blood vessels and tries to preserve organ function as much as possible. If surgeries do involve the organs, we work to minimize the impact on your daily life and support your recovery.
Head and neck surgeons often perform TransOral Robotic Surgery (TORS) to remove sarcomas. They work to minimize the potential impact of the operation on speaking, chewing, and swallowing. If you do experience side effects, we coordinate care with dietitians and speech and language therapists.
The spine contains sensitive nerves that control body parts such as the arms, legs, bladder, and bowels. Removing tumors in the spine and skull base (bottom of the skull) in one piece requires particular skill and expertise.
Operating in these complex locations involves careful planning and teamwork. Our team plans surgeries using 3D visualization. We also discuss possible impacts on function with you before proceeding. Depending on the location of your tumor, you may be cared for by a neurosurgeon as well as other specialized surgeons who will repair nerves or transfer them from other parts of the body or from donors. Physical therapists and orthotists can provide additional services for rehabilitation after surgery.
Our neurosurgeons typically use minimally invasive approaches to reduce the risk of complications. For upper spine and skull base sarcomas, they may use TORS, which allows them to access areas that are difficult to reach. When appropriate, they use GPS-like navigation during operations to make precise cuts.
If you are diagnosed with a uterine sarcoma, our team usually recommends a total hysterectomy (removal of the uterus and cervix) as part of treatment. An experienced Penn Medicine gynecologic oncologist performs the operation and oversees your care. We take careful steps to keep incisions small, while still keeping the cancer from contaminating other areas.
We may also recommend removing the ovaries and fallopian tubes in certain cases.
Removing tumors in the pelvis is complex, particularly if surgeons need to take out both soft tissue and bone. Our surgeons do their best to preserve mobility, using minimally invasive procedures such as laparoscopy or robotic-assisted surgery when appropriate.
Treating sarcomas that weren’t removed properly
Sometimes people seek our care after they’ve had surgery to take out a lump or bump that was previously misdiagnosed. Such removals happen when the tumor is mistaken for a noncancerous growth.
If you had a sarcoma that wasn’t taken out properly, you may need a second surgery with the possible addition of radiation therapy. Our team works to manage the risk of cancer spread or recurrence in such cases.
What to expect after sarcoma surgery
If you choose to have sarcoma surgery, you can expect to:
- Start recovering after leaving the operating room: Some people can have outpatient surgery; other may need to stay in the hospital for about two to six days after their operations.
- Continue healing outside the hospital: Some people are discharged from the hospital and go straight home, while others may need to go to a rehabilitation hospital to continue recovery. We may arrange for a nurse or physical therapist to come to your home to help you with your surgical bandages or mobility. Our team will also call to check in, review care instructions, and answer questions. You can always reach us by phone or through the MyChart by myPennMedicine patient portal.
- Come back for follow-up appointments: You’ll return two to three weeks after surgery to check on the incision and healing. From there, you’ll come back to the office every few months for scans to make sure the cancer hasn’t returned. You’re asked to follow that schedule for the first two years, with less frequent visits after that.
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:
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 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
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.
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)
Rated “exceptional” by The National Cancer Institute
Penn Medicine’s Abramson Cancer Center is a world leader in cancer research, patient care, and education. Our status as a national leader in cancer care is reflected in our continuous designation as a Comprehensive Cancer Center by the National Cancer Institute (NCI) since 1973, one of 7 such centers in the United States. The ACC is also a member of the National Comprehensive Cancer Network, one of a select few cancer centers in the U.S., that are working to promote equitable access to high-quality, advanced cancer care.