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NCCN Guidelines for Patients


Soft Tissue Sarcoma, Version 1.2014


Chart 2.2.2

maps the treatment options for

stages II and III that can’t be treated with surgery

at first. However, other treatments may shrink

the tumor so that surgery can be done. These

treatments include radiation therapy, chemoradiation,

chemotherapy, or isolated limb chemotherapy.

Isolated limb chemotherapy only treats the limb with

sarcoma. The drugs are injected into blood vessels

within the limb. This prevents chemotherapy from

affecting the rest of your body.

After treatment, your doctors will assess if you are

able to have surgery with good results. Good results

include a surgical margin larger than 1 cm, cancer-free

margins, and good use of your limb or other body part.

If you have surgery, you may have radiation therapy

if you had none before. If you had radiation therapy

before surgery, you may receive a radiation boost.

You may or may not also have chemotherapy after

surgery. The research on its benefits at this point

of care is limited. It is not clear if chemotherapy

is helpful. Joining a clinical trial that is testing

chemotherapy may be a good option.

There are treatment options if you are unable to have

surgery. Amputation should be used as a last resort.

Your doctors will consider many factors to decide

which other options are best for you.

Some patients can have radiation therapy. The goal

is to cure the cancer. The highest dose that doesn’t

cause severe side effects is recommended. If you

will have EBRT, treatment planning should use IMRT,

tomography, or protons.

If you can’t have radiation therapy and you have

no symptoms from the cancer, you may undergo

observation. Observation is a period of regular testing

for cancer growth so treatment can be started if


Palliative care is recommended if the cancer is

causing symptoms. There are three options. You may

have chemotherapy, surgery, or best supportive care.

Chart 2.2.3

lists care after cancer treatment has

ended. You should receive rehabilitation if needed.

This may include occupational or physical therapy.

You should also start to have follow-up tests to check

if the cancer has returned. Getting follow-up tests

can help find cancer early. Cancer is more likely to

be cured if found early. Tests include medical history,

physical exam, and imaging of your chest. If the

cancer is likely to return, you may get imaging tests of

the site where the primary tumor was.


Sarcomas in limbs, outer trunk, head, or neck Stages II and III sarcoma