Combining Radiation and Surgery to Attack Soft Tissue Sarcomas

Effective treatment of soft tissue sarcomas – cancers that can develop in fat, muscle, nerves, fibrous tissues and blood vessels – often requires a combination of surgery and radiation. That's why University of Maryland Cancer Network physicians work together to take a multi-disciplinary approach to treatment, leveraging new advances in radiation therapy for soft tissue sarcoma.

Specialized, Multidisciplinary Care

Each year about 13,000 people in the United States are diagnosed with adult soft tissue sarcomas, compared to more than 280,000 cases of breast cancer. Because soft tissue sarcomas are so rare, it's important for patients to see providers who specialize in their treatment, says Julia Terhune, MD, assistant professor of surgery at the University of Maryland School of Medicine.

UM Cancer Network physicians not only specialize in soft tissue sarcomas but also collaborate to diagnose and then treat patients through a multidisciplinary tumor board.

"Our weekly tumor board includes radiation oncologists, medical oncologists, pathologists who focus on soft tissue sarcomas, radiologists who focus only on musculoskeletal imaging and surgical, orthopedic and thoracic oncologists," she says. "We meet to discuss every patient, and based on the specifics of the patient's tumor, tumor type and tumor grade, we come up with an individualized treatment plan."

While chemotherapy and immunotherapy are available for certain types of soft tissue sarcomas, most treatment plans include surgery or a combination of surgery and radiation therapy, Terhune says.

Radiation Therapy Advances

Sometimes, surgery is enough to remove soft tissue sarcoma. But when additional therapies are needed, radiation oncologists can provide radiation before, during or after surgery.

"Our radiation oncologists have novel ways to administer the radiation so it remains a painless and minimally toxic way of delivering treatment while providing a local recurrence benefit," Terhune says.

In addition to conventional radiation with photons, UM Cancer Network radiation oncologists offer state-of-the-art proton therapy at the Maryland Proton Treatment Center – the first and most experienced proton center in the region.

Among the many proton therapy benefits: an increased radiation dose that stops at the tumor site.

"If you have a sarcoma in the abdomen, there are lots of nearby organs like your kidney, your stomach, your bowel and your liver that you don't necessarily want to deliver radiation to," says Dan K. Kunaprayoon, MD, an assistant professor of radiation oncology at the University of Maryland School of Medicine. "Protons have mass and a stopping power, so they stop at a depth in tissue. This can allow proton therapy to spare more normal tissue than conventional radiotherapy.";

Overall, radiation therapy can reduce the chances of soft tissue sarcoma recurrence by 50 to 70 percent – especially for angiosarcomas, liposarcomas and epithelioid sarcomas, he says.

The UM Cancer Network also participates in clinical trials to explore new radiation treatments for soft tissue sarcomas. For example, the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center is part of a multi-center trial exploring a combination of surgery, radiation and immunotherapy for patients with the disease, Dr. Kunaprayoon says.

Network Benefits

With the NCI-designated UM Marlene and Stewart Greenebaum Comprehensive Cancer Center as its hub, the UM Cancer Network offers patients access to nationally-renowned experts, cutting edge treatments and technologies and the latest clinical trials.

For soft tissue sarcoma patients, it also offers convenience.

"One of the great benefits of the network is patients can still receive some or all of their treatment close to home but also garner the expertise and specialization our centers allow," Dr. Terhune says. "We all work together to come up with a treatment plan that capitalizes on specialized care."

For example, a patient referred to University of Maryland Upper Chesapeake Medical Center for medical oncology can also receive a surgical oncology evaluation and radiation treatment on site and then undergo surgery at the University of Maryland Medical Center's downtown campus, she says.

"Patients can receive treatment in their own backyard while still accessing the expertise of the specialists downtown," Dr. Kunaprayoon adds. "It's a good way to have the best of both worlds."

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