Radiation Therapy for Sarcoma

Although surgery is the primary treatment for most sarcomas, radiation therapy is often considered as an additional treatment to reduce the risk of recurrence. Depending on the type and stage of cancer, radiation therapy may be used: 

• Before surgery, especially for soft-tissue sarcoma in the arms or legs. The goals are to shrink the tumor for a more effective surgery, save all possible functionality in the limbs, and reduce the risk of recurrence.
• After surgery, as an added measure to kill cancer cells that may have been left after surgery. The goal is to keep the cancer from recurring.  
• As the main treatment for people whose general health is too poor to undergo surgery
• As a palliative therapy, to improve quality of life for some patients with advanced disease

Quality Care by Experts in Sarcoma

At UC San Diego Health, your care is led by a team of board-certified surgeons, medical oncologists, and radiation oncologists who specialize in soft-tissue sarcoma and bone tumors and have access to state-of-the-art equipment. UC San Diego is a national leader in designing clinical trials, expanding your treatment options and giving you access to the latest sarcoma therapies.

Treatment techniques

Intensity-modulated radiation therapy (IMRT), a type of external beam radiation therapy, is the standard approach for most sarcoma patients at UC San Diego Health. This computer-guided technology can precisely target cancer cells, which reduces the radiation delivered to nearby normal tissue and minimizes side effects. When needed, we use X-ray or CAT scan technology (image guidance radiation therapy, or IGRT) to precisely locate an exact position. 

Our physicians also have expertise in and access to other sophisticated technical treatments, including:

• Brachytherapy, or internal radiation therapy, can be used by itself or in combination with external beam radiation therapy to treat sarcomas after surgery. This technique involves the placing plastic catheters in the area of the tumor removal during surgery. Several days later, the catheters are attached to a high dose rate (HDR) brachytherapy machine to deliver radiation directly to this area. It is useful when tumors are immediately adjacent to an important normal structure like blood vessels, nerves or bone (see image). Occasionally this treatment may allow the patient to avoid a more radical surgery.
• Sterotactic SBRT: This is an advanced type of external radiation therapy that delivers very precise and intense doses of radiation. It may be used with certain sarcomas that have spread to the brain or spine, or for tumors that don't shrink well with conventional treatment.
• Proton therapy: This therapy is sometimes appropriate for difficult-to-treat areas, especially those near the spine or nerves. In more typical cases, it has not been shown to be a better treatment than IMRT/IGRT.

IMRT technology can "shape" radiation so that it conforms to the area being treated. In this case, IMRT was used to limit radiation (yellow circle) going to the femur bone (white circle) to reduce the risk of fracture.

In this case, brachytherapy was used to deliver additional radiation (yellow line) to the portion of a sarcoma that was adhering to the bone (white circle).

What to Expect During Radiation Treatment

A typical course of pre-surgery radiation therapy for sarcoma is 15 minutes a day, five days a week, for five weeks, but there are many exceptions. Your radiation oncologist will determine the best treatment plan for you.

Side effects can vary, depending on the area that is treated and the dose that is given. Side effects that are specific to soft tissue and bone tumors may include:  

• Redness and irritation of skin over the treated area
• Possible swelling and mild tenderness of the treated area
• Stiffness in the treated area

Our team does its best to limit or help ease side effects.