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TYPES OF TREATMENT
- General
Surgery
In most cases, the radical
surgical procedures of the past (amputation) have given way to
a combined treatment approach: pre or postoperative radiation
therapy. The role of chemotherapy is less well defined. Because of
the evolving nature of the state of the art in the treatment of this
disease, all patients with such lesions should be included in a
clinical trial whenever possible. When muscles are involved,
surgeons have often removed the entire muscle group. If the tumor is
near the shoulder or hip, the entire joint has been removed. If the
tumor involves a major blood vessel, the vessel has been removed and
replaced with an artificial graft. When bone is removed, it can
often be replaced with bone graft or metal. Even after radical
excision local recurrence rates of 25-30% are common. Recently more
surgeons are practicing more conservative surgery, including limb
sparing techniques. .
Radiation
Therapy
Radiation
therapy is used to reduce local recurrence especially after surgery
that spared the limb from amputation. Doses of 6,000-7,000 cGy given
over six to seven weeks are common. Radiation may also be given
prior to surgery to reduce the size of a large tumor. Local
recurrence rates of 20-25% are common.
Chemotherapy
Chemotherapy has been very
effective in bone sarcomas, Ewing's sarcomas, and rhabdomyosarcomas.
Chemotherapy has been much less effective in other soft tissue
sarcomas. Adriamycin (Doxirubicin) is the most commonly used agent for soft tissue
sarcomas. Adjuvant chemotherapy is not very effective. Patients with
tumors, which are 5 cm or smaller are not usually treated with
adjuvant chemotherapy. Preoperative (neoadjuvant) chemotherapy can
be used to shrink large tumors prior to surgery. Patients with large
tumors or distant metastases may also receive treatment as
participants in a clinical trial.
Careful planning of the initial biopsy is important to avoid
compromising subsequent curative surgery to remove the whole tumor. Since the selection of
treatment is determined by the grade of the
tumor, it is essential to have a careful review of
the biopsy tissue by a pathologist who is experienced
in diagnosing sarcomas. Complete staging and treatment planning by a multidisciplinary
team (surgeon, medical oncologist, radiation oncologist, pathologist, and radiologist) of cancer specialists
has been proven to be the most beneficial for
patients in treatment of this disease. In most cases, the radical surgical procedures
of the past have given way to a combined treatment approach:
pre or postoperative radiation therapy, or pre or postoperative
chemotherapy.
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