Current Diagnostic and Treatment Algorithm for Soft Tissue Sarcomas
Sarcoma is a type of cancer that starts in tissues like bone or muscle. There are more than 50 different types of soft tissue sarcomas. Bone and soft tissue sarcomas are the main types of sarcoma. Soft tissue sarcomas can develop in soft tissues like fat, muscle, nerves, fibrous tissues, blood vessels, or deep skin tissues. They can be found in any part of the body. Most of them start in the arms or legs. They can also be found in the trunk, head and neck area, internal organs, and the area in back of the abdominal (belly) cavity (known as the retroperitoneum).
Because sarcomas are rare and complex, the best care comes from certified centers offering sophisticated and highly specialized services. Studies have shown that patients with sarcomas have better outcomes when they're treated at specialized cancer centers that have experience in sarcoma treatment.The experts in the partner clinics of German Health Advisors offer the latest treatment options available today, preserve healthy tissue and bone, and perform comprehensive limb-sparing surgeries to avoid the need for amputation.
The personalized care plan is the cornerstone of the success of the treatment of cancers in Germany. Each patient receives individualized treatment plan depending on tumor type and stage of progression. Because there are so many different types of soft tissue sarcomas, it's important to determine the exact nature of each tumor so that the best treatments can be chosen.
Initial Staging and Risk Assessment
The staging for overseas patients is usually not complete when they contact us for a second opinion and any subsequent treatment recommendations. The system employed by German Health Advisors, however, allows for the completion of this stage while the patient is in his homeland. It is not necessary to come to Germany for cancer staging. You will be informed if there are any obstacles in the staging process. For the staging of the sarcoma, please bear the following in mind:
- Family history, physical examination, blood count and differential, liver and renal function tests need to be obtained (see the request form for German Health Advisors). This will usually be carried out by our local colleagues and documented in the form of a doctor’s letter.
- If a soft tissue sarcoma is suspected based on exams and imaging tests, a biopsy (core needle or surgical biopsy) is needed to know for sure that it's a sarcoma and not another type of cancer or a benign disease. In our partner clinics in Germany surgical biopsy will be favored. If the biopsy was already taken, please provide us with your pathology report. In some cases, when our specialists are not satisfied with the quality of a pathology report, we will contact you with a recommendation for further steps. You may have to send us the frozen/paraffin embedded tissue samples for further histology investigation at one of German Health Advisors’ partner laboratories in Germany.
- Imaging to be done: MRI to evaluate the area of concern and computed tomography (CT) scan of the thorax and abdomen to rule out the metastasis. In selected patientsMR angiography of an extremity might be needed. You can send the DICOM files of CTscans using German Health Advisors’ secure data transfer system. Our experience shows that the quality of radiology images might not be good enough to correctly stage the cancer. In such cases, we will contact you in order to work towards a solution. It is of great importance for us to have high quality radiology images from our local colleagues. This greatly assists in defining the diagnostic and treatment plan in timely fashion and helps to avoid unnecessary expenses.
Treatmentof Soft Tissue Sarcoma
The treatment options for soft tissue sarcoma will depend on the size, type and location of the tumor. The best therapy plan will be discussed during the tumor boards of our partner clinics. Below we list the main current treatment options:
- Surgery is a common treatment for soft tissue sarcoma. It generally involves removing the cancer and some healthy tissue surrounding it. When soft tissue sarcoma affects the arms and legs, radiation and chemotherapy may be considered to shrink the tumor to avoid amputation.
- Radiation therapy involves treating cancer with high-powered beams of energy. Options are - Radiation before surgery can help shrink the tumor so that it's easier to remove; Intraoperative radiation allows a higher dose of radiation to be delivered directly to the target area, while sparing surrounding tissues; Postoperative radiation can help kill any remaining cancer cells.
- Depending on the type and stage of sarcoma, chemotherapy may be given as the main treatment or as an adjuvant (addition) to surgery. Different types of sarcoma respond better to chemotherapy than others and also response to different types of chemotherapy varies. Chemotherapy for soft tissue sarcoma generally uses a combination of several anti-cancer drugs.
- Targeted drug treatment.Some types of soft tissue sarcomas have specific characteristics in their cells that can be attacked via targeted drug treatments. These medicines work better than chemotherapy and aren't nearly as toxic. Olaratuma is one of the best verified drugs for the treatment of Soft Tissue Sarcoma.
Isolated limb perfusion (ILP). ILP is a different way to perform chemotherapy. This involves giving high doses of chemotherapy or targeted therapy drugs directly into the affected limb. The blood supply to the limb (arm or leg) is isolated from the rest of the body so that the drugs do not go to other areas of your body. ILP may be used to treat tumors that cannot be removed or to treat high-grade tumors before surgery. It can help shrink tumors and make limb-preserving surgery possible. ILP should only be done at centers with a lot of experience in giving chemo this way. The Sarcoma Center in Frankfurt (Director: Prof. Schwarzbach M.) currently performs isolated limb perfusion with TNF-alfa and Melphalan in selected patients, which is demonstrating effective downstaging of the tumor and allowing preservation of the extremities.
Follow-Up AfterTreatment of Soft Tissue Sarcoma
Follow-up should be tailored to the individual patient and the stage of the disease. The German Health Advisors’ partner clinics will normally schedule follow-ups in this manner:
- Every 3 months for the first 2 years: physical examination and MRI of the area of concern
- Every 6 months for the first 2 years: computed tomography (CT) scan of the thorax
- Every 6 months for the next 3 years: physical examination and MRI of the area of concern
- Every 12 months for the next 3 years: computed tomography (CT) scan of the thorax
Patients, who received their treatments in Germany, usually do not need to return to Germany for the follow-up visits. German Health Advisors will provide you with follow-up care through its Telemedicine platform.
1. Current Concepts in the Management of Retroperitoneal Soft Tissue Sarcoma. Schwarzbach, Matthias HM, and Peter Hohenberger. "Current concepts in the management of retroperitoneal soft tissue sarcoma." Treatment of Bone and Soft Tissue Sarcomas. Springer, Berlin, Heidelberg, 2009. 301-319.
2. Sweiti, Hussein, et al. "Limb-Salvage Surgery of Soft Tissue Sarcoma with Sciatic Nerve Involvement." Sarcoma, 2018.