Non-Surgical Management

CHEMOTHERAPY

Cancer by nature has a propensity to spread to other parts of the body. The metastatic deposits may be big enough to be visible in the scans or may small and may go unnoticed, so every patient with cancer is assumed to have spread. Some sarcoma cells are sensitive to chemotherapy drugs. Chemotherapy is treatment given using drugs which have the ability to destroy the cancer cells. These drugs when given in the prescribed dose can help in cure or control of the cancer. In sarcomas it is used as an adjuvant therapy along with surgery and Radiotherapy. The chemotherapy treatment is usually given by the medical or clinical oncologist.

Side effects

These chemotherapy drugs are very toxic not only to the cancer cells but also to the normal cells of the body. These effects may present in the form of hair loss, ulcers in the mouth, nausea, vomiting, loss of appetite, low sperm count, bone marrow suppression, fever etc.

To counter some of the side effects rescue medications are usually given which will minimize the complications.

Serious complications like bone marrow suppression, fever etc. need immediate and focused treatment. Patient may need admission for short duration. Granulocyte growth stimulating factors and antibiotics are usually given. During chemotherapy, strict dietary care needs to be taken as per the medical oncologist advice.

In male children who may receive drugs like Ifosfamide are counselled prior to chemotherapy for permanent complications like low sperm count. The parents of these children may opt for voluntary sperm preservation in special sperm banks for later use. Similarly, oocyte preservation is addressed in girls who have attained menarche.

Chemotherapy may also be given as a palliative treatment when the tumor has spread to different parts of the body and cure is not possible. In this scenario, chemotherapy helps to prolong the life expectancy and improve quality of life.

RADIOTHERAPY

In Radiation therapy, ionizing radiation beams are given in a controlled method to the tumor zone in order to destroy the cancer cells.

In sarcomas, radiation treatment is indicated in:

  1. Bone sarcoma: Either given before or after surgery. Ewing sarcoma involving bone where surgery is difficult or the morbidity is high, may be treated with only chemotherapy and radiation therapy. Some tumors where the size is big and surgical excision is difficult, radiation treatment may be given to bring down the size of the tumor and then surgery may be performed.
  2. Soft tissue sarcoma: usually radiation treatment is given to the tumor bed after it has been removed surgically. Radiotherapy may be given before surgery as well.
  3. Radiotherapy may also be given as a palliative treatment when the tumor has spread to different parts of the body and surgical removal is not possible. This is aimed at relieving the patient of pain and improving the quality of life.
  4. In Bone Metastases:
    1. Local field radiation Therapy: To palliate pain (partial relief in about 50 -80 % of patients and rest with complete response) over multiple sessions (total dose in fractions)
    2. Stereotactic body radiation therapy: Single high fraction dose beam of radiation is used to target tissue and minimise unwanted radiation exposure to surrounding tissues.

After Radiotherapy a few patients may experience complications like skin ulceration, swelling of the hand or the leg affected by cancer, delay in wound healing etc. A rare complication is secondary cancer occurring due to radiation in the affect region after many years.

 

RADIO-PHARMACEUTICALS

Certain bone seeking radio-pharmaceuticals are injected leading to uptake of these particles in osteoblastic sites in bone metastases. Strontium-89, Samarium-153, Phosphorous-32 and Radium-223 are used commonly. This technique allows a targeted therapy helping regress the lesion and provide pain relief in multi-focal bone involvement.