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NCCN Guidelines for Patients


Soft Tissue Sarcoma, Version 1.2014



Sarcoma basics

Local treatments

Local treatments

Local treatments are used to treat a focused area of

cancer. Surgery and radiation therapy are common

local treatments. Ablation and embolization are

sometimes used for small tumors that aren’t near

to where the cancer started. One example is small

tumors in the liver.


Surgery has been used as a primary treatment for

sarcoma for a long time. Primary treatment is the

main treatment used to rid the body of cancer. As

such, the goal of surgery is to remove all the cancer.

Surgery may also be used to reduce symptoms

caused by the cancer or extend life. This is called

palliative or supportive care.

The method and extent of surgery for sarcoma varies.

Both depend on where the sarcoma is and the size of

the tumor. Ask your treatment team for details of how

the tumor will be removed.

Your surgeon will try to remove a cancer-free surgical

margin. A surgical margin is a ring of normal-looking

tissue around the tumor. Sometimes a cancer-free

margin can’t be removed. If this is expected, your

surgeon will place clips in your body after removing

the tumor. The clips help doctors give you radiation

therapy where it is needed. Sometimes, a second

surgery can be done instead.

Your doctor will also try to remove as little tissue as

possible. This is done so you can use your limbs or

other body parts after surgery. For some people, their

limb may need to be removed (amputated) in order to

remove all the cancer.

Side effects are unhealthy or unpleasant physical

or emotional responses to treatment. You may

experience side effects from the anesthesia or

the surgery. Often, general anesthesia is used for

surgery. General anesthesia is drugs that put you into

a deep sleep-like state so you won’t feel pain. Ask

your treatment team for a list of all rare and common

side effects of the surgery you will have.

Radiation therapy

Radiation therapy uses high-energy rays to treat

cancer. The rays damage DNA (






cid). DNA is a chain of chemicals in cells that

contains genes. This either kills the cancer cells or

stops new cancer cells from being made.

Radiation therapy has many uses for sarcomas. It

may be used as a primary treatment like surgery.

Radiation therapy given before surgery is called

neoadjuvant treatment. It is used to shrink the tumor

for surgery. Radiation therapy can also be given

during or after surgery to kill any remaining cancer

cells. Radiation therapy given during surgery is called









herapy). When given

after surgery, it is called adjuvant treatment. You

may receive a full dose of radiation, or if receiving a

“boost,” less than a full dose. A boost is only used for

neoadjuvant treatment.

There are two main methods to give radiation.

Which method you may get depends on the type of

sarcoma and the purpose of radiation therapy. The

two methods are discussed next. You may feel side

effects from radiation although not everyone does.

Ask your treatment team for a full list of common and

rare side effects.

External beam radiation therapy

Radiation is often given using a machine outside the

body. This method is called EBRT (








herapy). To receive EBRT, you first must

have a simulation session. For simulation, imaging

scans are used to help target the tumor with radiation.

Using the scans, your treatment team will plan the

best radiation dose, number and shape of radiation