Chemotherapy for soft tissue sarcomas

Chemotherapy (chemo) is the use of drugs given into a vein or taken by mouth to treat cancer. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread (metastasized) to other organs. Depending on the type and stage of sarcoma, chemotherapy may be given as the main treatment or as an adjuvant (addition) to surgery. Chemotherapy for soft tissue sarcoma generally uses a combination of several anti-cancer drugs.

The most commonly used drugs are ifosfamide (Ifex^®) and doxorubicin (Adriamycin^®). When ifosfamide is used, the drug mesna is also given. Mesna is not a chemo drug. It protects the bladder from the toxic effects of ifosfamide.

Other chemo drugs may be used as well, including cisplatin, dacarbazine (DTIC), docetaxel (Taxotere^®), gemcitabine (Gemzar^®), methotrexate, oxaliplatin, paclitaxel (Taxol^®), vincristine, and vinorelbine (Navelbine^®). When several drugs are used together, the combination is given a shortened name such as: MAID (mesna, doxorubicin [Adriamycin], ifosfamide, and dacarbazine).

Chemotherapy drugs kill cancer cells but also damage some normal cells. Side effects depend on the type of drugs, the amount taken, and the length of treatment. Common chemo side effects include:

• Nausea and vomiting
• Loss of appetite
• Loss of hair
• Mouth sores
• Fatigue
• Low blood counts

Because chemotherapy can damage the blood-producing cells of the bone marrow, patients may have low blood cell counts. This can result in:

• Increased chance of infection (from too few white blood cells)
• Problems with bleeding or bruising (from too few blood platelets)
• Fatigue and weakness (from too few red blood cells)

Most side effects disappear once treatment is stopped. Hair will grow back after treatment ends, but it might look different. There are remedies for many of the temporary side effects of chemotherapy. For example, anti-emetic drugs can be given to prevent or reduce nausea and vomiting.

Some chemo side effects can last a long time or even be permanent. For example, doxorubicin can weaken the heart if too much is given. If you are to be treated with this drug, your doctor might check your heart function with special studies before starting this drug. The doctor will also watch the dose of doxorubicin closely during therapy.

Some chemo drugs cause nerve damage (called neuropathy), leading to numbness, tingling, or even pain in the hands and feet. Chemotherapy may also permanently damage ovaries or testicles, which can lead to infertility (not being able to have children).

If you will be getting chemo, ask your health care team about the drugs used and their possible side effects.

Hyperthermia and limb perfusion

This procedure is a different way to give chemo. The circulation of the limb (arm or leg) with the tumor in it is separated from that of the rest of the body. Chemo is given just to that limb and the blood is warmed up a bit to help the chemo work better. This has been studied for many years, but it is still not a standard part of the treatment for soft tissue sarcoma. Still, it may be able to help people live longer than standard chemo. It should only be done at centers with a lot of experience in giving chemo this way.