Surgery

Surgery is usually the best treatment for a sarcoma—especially now that the growth and spread of the disease is better understood and imaging tests have improved—all of which helps us plan surgeries that remove tumors while sparing as much healthy tissue as possible.

Our surgeries are performed by specialists who:

  • Are internationally recognized for their expertise with complex sarcoma surgery—treating patients referred from across the country and the world
  • Help patients who received initial surgery elsewhere and now need additional care
  • Use advanced techniques on arm and leg tumors to preserve a greater degree of function, often sparing the whole limb (98 percent success rate)
  • Repair surgical areas (when needed) with sophisticated bone grafts or special prostheses, many of which can expand with younger patients as they grow

We offer top follow-up care, too, with a full rehabilitation program—often a crucial part of making treatment a success.

Types

Our team has developed a number of innovative surgical techniques to remove tumors safely and accurately. We use several types of sarcoma surgery:

  • Wide Local Excision: Excision removes the tumor and some healthy tissue around it—a step we try to minimize, especially when the cancer is in the head, neck, abdomen, or trunk. After the tumor is removed, the bone is fixed, the soft tissues repaired and the skin closed, with the goal of preserving function and appearance.
  • Lymphadenectomy (Lymph Node Dissection): Lymph nodes are removed and samples are checked under a microscope for cancer.
  • Rotationplasty: Doctors remove the tumor and knee joint, using the ankle as a new knee when the leg is reconstructed and usually attaching a prosthesis to the foot.

Surgery is often combined with chemotherapy, radiation (mainly for soft tissue sarcomas) or, in the case of a soft tissue sarcoma called a gastrointestinal stromal tumor (GIST), a targeted therapy.

Limb-Sparing Sarcoma Surgery

Thanks to advances in surgery, radiation, and chemotherapy, we can usually save arms and legs with sarcomas rather than amputate them. But limp-sparing surgeries remain complex and are best left to specialized experts like ours:

  • Surgeons not only have to ensure the entire tumor is removed, but save tendons, nerves, and blood vessels to preserve as much function and appearance as possible.
  • Once the tumor is gone, surgeons must then make repairs. This may include transferring muscles and tendons and replacing bone and joints—either with a graft taken from another part of the body or with a manmade implant (prosthesis).

We have a 98 percent success rate with saving limbs, though patients still require full rehabilitational support to make their surgery a success and retain function.

On the rare occasions we need to amputate, we provide a full range of physical and emotional support, including reconstruction specialists.

Reconstruction and Prostheses

After removing a tumor, our surgeons may need to replace portions of the skeleton with a manmade implant (an internal prosthesis, or endoprosthesis) to help with stability and function.

We specially select and customize each implant to ensure the best possible fit and performance for each patient. Many newer implants can even grow with younger patients, so we don’t have to perform more surgery to replace or adjust the equipment. But these prostheses may still need replacement with an adult model once a child stops growing.

Shoulder Girdle Surgery

After the limbs, the shoulder girdle (several major bones in the shoulder area) is the most common site for bone sarcomas. It’s now possible to avoid amputation and maintain function of the shoulder, arm, wrist, and hand, removing the cancer and using a prosthesis to reconstruct the bone and joint.

But the shoulder girdle is a very complicated area and requires an experienced and skilled team. Our surgeons are world leaders in performing this complex surgery.

Complex Sarcoma Surgeries and Revisions

Sarcoma surgery is particularly complex when it involves large tumors or hard to treat areas such as the pelvis and spine. Other centers (even some from around the country and the world) refer these cases to us because of our skilled orthopedic surgeons and their access to other cancer specialists at MedStar Health.

This same experience is also useful for providing revision surgery—surgery to finish or redo a previous operation to correct problems or improve function, including for tumors that were only partially removed or have grown back.

Our team has a great deal of experience dealing with these cases and offers innovative solutions to very challenging problems. Many of the revision surgeries we perform are for patients who were treated at other institutions and then got referred to us.

Minimally Invasive Sarcoma Ablation

For some tumors, we destroy their cells with minimally invasive ablation—either heating them (radiofrequency ablation) or freezing them (cryosurgery). This is done after surgery or instead of surgery, with a needle-like probe, advanced imaging equipment, and collaboration between our orthopedic oncologists and interventional radiologists.

Chemotherapy

Chemotherapy drugs are swallowed or injected then travel through the bloodstream to kill cancer cells. They are used to shrink sarcomas before surgery or given afterward to make sure the cancer does not return or spread. In some cases, chemotherapy is given by itself to treat a tumor.

The type of chemotherapy depends on the type of tumor, its stage, and whether the cancer is newly diagnosed or has returned. Drugs are typically given together, and we are studying new medications, new combinations, and more effective ways of delivering them.

While we always try to minimize the side effects of chemotherapy, we are particularly sensitive to limiting toxic exposure as much as possible for children who are still growing.

Chemotherapy and Arterial Embolization

For certain sarcomas, we can inject chemotherapy drugs directly into the blood vessels that feed the tumor, to stop its growth and minimize the exposure of healthy tissue. This is called intra-arterial chemotherapy (IAC).

Radiation

Radiation therapy uses high-energy X-rays or other radiation to kill cancerous cells. When needed in sarcoma treatment, we use it with surgery or chemotherapy to shrink tumors or prevent cancer from returning . In some cases, radiation is used by itself—usually when surgery is not an option.

Radiation treatment depends on the type of sarcoma and the cancer’s stage. While we always try to minimize the side effects of radiation, we’re particularly sensitive to the vulnerability of children who are still growing. We try to limit doses and, whenever possible, avoid the therapy altogether.

Radiation therapy is getting safer and sparing more healthy tissue, though, thanks to specialized, focused beams of radiation, sophisticated computer programs, and advanced imaging.

Types

When needed, sarcomas are treated with external radiation delivered by a machine. We use two types:

  • Three-Dimensional Conformal Radiation Therapy (3D-CRT): Radiation beams are sculpted to a tumor’s particular shape—useful when they are irregular or close to healthy tissues and organs. We view the tumor in 3D and deliver radiation from several directions.
  • Intensity-Modulated Radiation Therapy (IMRT): Our radiation oncologists can change treatment intensity as they go based on tissue type, delivering specific doses to different parts of a tumor and sparing healthy tissue. This is particularly useful for tumors in hard-to-treat areas such as the spine or pelvis.

Targeted Therapy

Targeted therapy represents a new front in attacking cancer—drugs and other substances aimed at specific molecules that help tumors grow, progress, and spread. The idea is to target a tumor’s unique characteristics, including genes, proteins, supporting blood vessels, or host tissue, while limiting damage to healthy cells.

Targeted therapies may replace current sarcoma treatments, or complement them, and we are studying a number of new targets and approaches:

  • Growth Factor Receptors: Block proteins on some cancer cells that cause them to grow
  • Monoclonal Antibody: Replicates a natural antibody, then targets certain substances on cancer cells—either alone or with a drug, toxin or radioactive material to kill the cells, block their growth or keep them from spreading
  • Kinase Inhibitor: Blocks a protein cancer cells need for their division
  • Immune Modulators: Boost the body’s own immune system to fight cancer

Gastrointestinal Stromal Tumor (GIST) Treatment with Gleevec

The targeted therapy imatinib (trade name Gleevec) is already approved for treating gastrointestinal stromal tumors (GIST), a type of soft tissue sarcoma. Imatinib is typically recommended for a year after surgery to ensure the cancer does not return. It’s also used when tumors are too large for surgery, in attempt to shrink them and make them operable.

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