Chemotherapy in Sarcomas

Chemotherapy in sarcomas is currently the standard initiation care.
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 be small and may go unnoticed, so every patient with cancer is assumed to have spread.

Some bone and soft tissue sarcoma cells are sensitive to chemotherapy drugs. These are:
- Osteosarcoma
- Ewing’s sarcoma
- Undifferentiated Pleomorphic sarcoma
- Synovial sarcoma
Chemotherapy is treatment given using drugs which have the ability to destroy the cancer cells.
This is provided by Medical Oncologist
These drugs when given in the prescribed dose can help in cure or control of the cancer.
The drugs are given in weekly cycles or as tailored based on diagnosis and patient characteristics.

Role of Chemotherapy in soft tissue sarcomas is controversial, still up for debate due to limited benefit. It can be used as adjuvant treatment in synovial sarcoma and metastatic situation.
Patients with bone metastases are also prescribed chemotherapy.

For Primary Bone & Soft Tissue Sarcomas Chemotherapy can be given Preoperative and Postoperative also
In Ewing’s sarcoma , the standard drugs used as Vincristine. Adriamycin and Cyclophosphamide alternating with Ifosfamide and Etoposide in either 2/3 weekly interval (VAC-IE)
In Osteosarcoma, the standard drugs used are Adriamycin and Cisplatin with Methotrexate Or Ifosfamide (MAP/IAP).
Newer modalities like Targeted therapy, Immunotherapy are showing promising results.

Destroys cancer cells and prevents recurrence.
Provides a prognosis for course of treatment (one can evaluate based on response to chemotherapy)
Preoperative chemotherapy helps in following ways by reducing morbidity of surgery
- Can facilitate in shrinking the tumour
- Reduce vascularity of tumour
- Allows time for planning and manufacturing custom tumour prosthesis in some cases

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 a 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.
Drugs like Ifosfamide are counseled prior to chemotherapy for permanent complications like low sperm count.
The parents of adolescents who have attained maturity may opt for voluntary sperm or ova preservation in special sperm banks for later use.
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.

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