Welcome to Our New Educational Section:
At SaRC-Q, we understand the complexities and challenges that come with a sarcoma diagnosis. To empower our patients, caregivers, and the wider community with knowledge and understanding, we’re excited to introduce our comprehensive educational section dedicated to sarcoma types, their diagnosis, their treatments and management, as well as the different phases in clinical trials and how they can be explained.
Sarcoma types
Clinical trials phases
Treatment & Management
Targeted therapy in cancer treatment focuses on specific proteins that dictate how cancer cells grow and spread. By understanding these proteins better, researchers can design treatments to precisely target them, paving the way for more effective and personalized medicine.
What is Radiotherapy?
Radiotherapy uses ionizing radiation to damage the DNA of cancer cells, preventing them from multiplying and eventually causing their death.
The radiation is precisely directed at the tumor area while minimizing exposure to the surrounding healthy tissues.This approach allows the majority of the radiation dose to be concentrated on the tumor while limiting the dose delivered to nearby tissues.
In addition, cancer cells are generally more sensitive to radiotherapy than normal cells, while healthy tissues have a better ability to repair themselves after exposure to radiation. This helps destroy tumor cells while minimizing damage to healthy tissues.
What Is the Role of Radiotherapy?
Radiotherapy is an important component in the treatment of soft tissue sarcomas. It is often used in combination with surgery to reduce the risk of local recurrence.In soft tissue sarcomas of the extremities, this approach helps preserve the limb and avoid more radical surgical procedures.
When Is Radiotherapy Recommended?
Your physician may recommend radiotherapy if:
-The risk of recurrence after surgery is high-The tumor is of intermediate or high grade
-The tumor is large or located deep within tissues-The location or size makes complete surgical removal with adequate margins difficult
-Surgical margins are positive or very close
-The tumor is unresectable
Very small tumors ( less than 5 cm ), low grade and superficial, that can be completely removed with wide margins do not always require radiotherapy.
When Is Radiotherapy Given?
Before Surgery (Preoperative / Neoadjuvant Radiotherapy)
Advantages:
-Lower total radiation dose
-Smaller irradiated volume
-Shorter treatment duration
-May reduce tumor sizeLower rates of long-term side effects
(fibrosis, edema, joint stiffness)
Main disadvantages:
-Increased risk of postoperative wound complications (30–35%), particularly for tumors of the lower limb
-Possible tumor progression during radiotherapy, often related to inflammation or edema caused by treatment
After Surgery (Postoperative / Adjuvant Radiotherapy)
This may be recommended if:
-Surgery must be performed quickly due to significant symptoms (e.g., severe pain, nerve compression, ulcerated or bleeding lesion)
-The surgical team prefers to wait for final pathology results before proceeding with radiotherapy
-High-risk factors are detected after final pathological analysis
-The goal is to reduce perioperative complications
How Is Radiotherapy Administered?
Standard Schedule (Conventional Fractionation)
Before surgery (preoperative):
-50 to 50.4 Gy in 25 fractions over 5 weeks
-After surgery (postoperative): 60 to 66 Gy in 30 to 33 fractions over 6 to 7 weeks
Treatment is given once per day, Monday to Friday.
Timing Before Surgery
If radiotherapy is given before surgery, the operation generally takes place four to eight weeks after completion of treatment to allow acute radiation effects to resolve.
Shorter Schedules (Hypofractionation or Ultra-fractionation)
-42.75 Gy in 15 fractions over 3 weeks
-30 Gy in 5 fractions over 10 days
These shorter schedules may be more convenient, particularly if you must travel to a specialized center.
Steps of Treatment
1-Initial Consultation with the Radiation Oncologist
2-Treatment Planning (Simulation)
-Immobilization devices to ensure reproducible positioning
-CT and/or MRI in the treatment position
-Personalized treatment planning over 1 to 2 weeks
3-Treatment Sessions
-Treatments daily or every other day
-Approximately 20 minutes per session, including positioning
-Daily imaging for accuracy
-Radiation delivery is painless and invisible
4-Weekly Follow-up During Treatment
Follow-up visits with the medical team throughout the treatment period.
5-Clinical Follow-up
Follow-up with the surgical team, including chest imaging.
Your Care Team
1- Radiation Oncologist
Your radiation oncologist is the specialist physician who prescribes radiotherapy treatments. They will discuss your treatment plan with you, monitor your progress, and adjust the plan if needed. They work closely with the rest of the care team described below.
2- Residents and Fellows
Residents and fellows are physicians (M.D.) completing specialized training in radiation oncology. They are actively involved in all aspects of care, including consultations, treatment planning, follow-up during radiotherapy, and post-treatment follow-up visits. They also participate in teaching and research activities that advance the field.
3- Radiation Oncology Nurses
Radiation oncology nurses listen to your concerns, answer questions, provide support, and manage treatment side effects. They may also help you access hospital and community resources.
4- Radiation Therapists
Radiation therapists have several roles:
-Perform simulation imaging (CT simulation and/or MRI simulation)
-Deliver your daily treatments
-In some centers, a radiation therapist may be designated as a point of contact, acting as a liaison between you and your radiation oncologist and available during business hours for questions or concerns.
5- Dosimetrists
Dosimetrists are specialists responsible for planning the radiotherapy treatment based on images obtained during the CT simulation scan. They focus on targeting the tumor while protecting nearby healthy tissues. They work closely with the radiation oncologist, who defines the areas to treat and avoid, and with the medical physics team to design an optimal and personalized treatment plan.
6- Medical Physicists
Medical physicists are scientists responsible for the safety and quality control of radiotherapy treatments. They perform rigorous quality checks on many aspects of treatment planning and delivery. They regularly verify radiotherapy machines to ensure they meet national and international standards. They also contribute to research projects that advance technology and oncology.
7- Clinical Nutritionist & Social Workers
A clinical nutritionist helps patients manage nutrition challenges related to cancer or treatment side effects and maintain adequate nutritional intake. A social worker provides counseling, assesses individual needs, and helps patients and families access support services, including financial assistance.
8- Clinical Research Coordinators
Clinical research coordinators oversee clinical trials to ensure they are conducted safely, ethically, and according to the study protocol. You will meet them if you choose to participate in a clinical trial. They will provide consent forms and help schedule your tests and follow-up visits according to the study protocol.
9- Administrative Staff
Administrative staff are essential. They are often the first people you meet when you arrive at the radiation oncology department. They assist with appointment check-in, scheduling or modifying appointments, and obtaining forms and parking permits.
Special Situations
-Dose reduction may be considered for myxoid histology
-Unresectable tumors: high doses (63–80 Gy) ± ablative techniques (SFRT, SBRT, brachytherapy)
-Palliative radiotherapy aimed at symptom relief rather than cure
-Metastatic sarcoma: ablative radiotherapy (SBRT) in combination with systemic therapy (immunotherapy, targeted therapy, etc.)
-Recurrent disease: re-irradiation may be possible using specialized techniques (e.g., brachytherapy)
-Ewing sarcoma is not covered in this text
Side Effects
Possible Acute Effects (during and shortly after radiotherapy)
-Skin reactions (40–70%): redness, dryness, peeling, darkening. Skin changes vary depending on skin tone: Light skin: pink, red, or darker; Brown skin: burgundy or darker; Dark skin: darker with yellow, purple, or gray tones
-Pain
-Thinning or loss of hair in the treated area
-Mild to moderate fatigue
-Wound-healing complications (30–35%, especially with preoperative treatment)
-Limb swelling (edema)
Some Location-Specific Risks
-Lung inflammation (cough, shortness of breath)
-Digestive changes
-Urinary symptomsTumor growth during preoperative radiotherapy due to inflammation (not caused by radiotherapy itself)
-Infertility
Possible Late Effects (months to years later)
-Fibrosis (12–40%)
-Joint stiffness (12–32%)
-Lymphedema (3–19%)
-Permanent skin changes
-Chronic pain (~7%)
-Localized osteopenia or bone fracture (2–6%)
Severe late effects (grade ≥3) occur in less than 5% of patients with modern techniques.
What You Can Do to Reduce Side Effects
-Stay active; gentle movement can help
-Ask for a physiotherapy referral if a limb is being treated
-Get enough rest
-Manage digestive symptoms with medication and/or a dietitian if needed
-Drink enough water
-Use appropriate skin care, wear loose clothing, and protect treated skin from the sun
-Take medications (e.g., pain relief) as prescribed
-Discuss sexual changes with your care team if applicable
-Seek help with smoking cessation (coaching, medications, etc.)
-Stop or reduce alcohol consumption
Questions to Ask Your Doctor
-Do I need radiotherapy?
-Should I receive it before or after surgery?
-What treatment schedule do you recommend?
-What side effects should I expect?
-How will this affect my daily activities?
-How can I manage side effects?
Your sarcoma care team (surgeon, radiation oncologist, medical oncologist, pathologist, and radiologist) will work together with you to develop a treatment plan tailored to your situation.