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Name of Treatment Program: Sarcoma and Soft Tissue Cancers

Short description: Our Center for Sarcoma and Connective Tissue Oncology is one of the largest and most experienced sarcoma treatment groups in the country.

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Our Approach

The Center for Sarcoma and Connective Tissue Oncology at Massachusetts General Hospital Cancer Center specializes in the diagnosis and treatment of bone and soft tissue tumors, both malignant and benign. The team represents one of the largest sarcoma treatment groups in the country.

Our patients also have access to The Harris Center for Chordoma Care, a specialized program at the Cancer Center dedicated to chordoma research and care.
Multidisciplinary Patient CareBecause the treatment of these cancers is complex, highly specialized experts are needed to guarantee the best possible outcomes. Each patient in our program is cared for by a multidisciplinary team of experts who specialize in the diagnosis and treatment of sarcomas and connective tissue cancers. Each patient’s medical team works together throughout care and follow-up, ensuring a seamless continuity of care.

Among the specialists in our program are:

• Adult and pediatric medical oncologists
• Radiation oncologists
• Orthopedic oncology surgeons
• Musculoskeletal radiologists
• Specialized pathologists with expertise in bone and soft tissue tumors
• Specialized oncology nursing staff

Expertise in Diagnosing and Staging CancersSarcomas are rare, complex and difficult to diagnose.  Our experts in radiology and pathology are highly specialized. They evaluate, diagnose, and stage these cancers.  This process usually includes imaging, surgery, and pathologic evaluation.
ImagingOur program uses the most advanced technologies available to detect and stage sarcomas and soft tissue cancers. Among these techniques are:

• CT scans
• CT guided needle biopsy
• MRI
• PET and PET/CT

SurgicalWhen an area of concern appears during an imaging test, we may perform a surgical biopsy to gather a tissue sample for testing. The types of biopsies include:

• Fine needle biopsy, in which a fine needle is inserted into the area of the suspect tissue and a sample is withdrawn
• Core needle biopsy, the same procedure as above, using a larger needle to gather more material. This is often done with image-guidance, using ultrasound or CT, to accurately guide the needle to the most appropriate location within the tumor.
• Incisional or excisional biopsy, in which a surgeon removes a portion of (incisional, used for large tumor) or the entire (excisional, used for small tumor) mass to obtain appropriate tissue to make the diagnosis

PathologyThe pathologists in our program are expert at diagnosing bone and soft tissue tumors, both benign and malignant. They use the latest technologies and techniques, including molecular diagnostic techniques and tests for genetic abnormalities. This detailed information guides treatment decisions, leading to more appropriate and targeted treatment for each individual patient.

In addition, our pathology specialists are engaged in numerous research projects to develop better ways to diagnosis and understanding the pathogenesis of these tumors.
Comprehensive Treatment ApproachesOur multidisciplinary group of clinicians represents one of the largest sarcoma treatment groups in the country. Our orthopedic oncologists have dedicated their clinical practice to the treatment of bone and soft tissue tumors, giving them the ability to see a large number of patients with these rare tumors and making them leaders in their field.

A treatment plan for sarcoma or soft tissue cancer may include surgery, radiation, and chemotherapy or some combination of all three. It may also include reconstructive surgery, possibly using soft tissue or bone grafts and/or bone prostheses (i.e. metallic replacement of bone involved by tumor).
Excellence in Surgical CareSurgery is an important treatment for these tumors. Ideally, the sarcomashould be removed with a clear margin of normal tissue around the tumor, at times following treatment with chemotherapy, radiation, or both. However, soft tissue  and bone sarcomas can arise in difficult anatomic locations and may require sophisticated surgical expertise to remove them in their entirety with appropriate reconstruction to provide the best possible result. Our surgeons are expert in surgically treating cancers in these difficult locations, including:

• Extremity, where tumors can arise adjacent to major nerves, blood vessels, bones, and joints
• Abdomen, where intra-abdominal and retroperitoneal tumors often abut major organs, blood vessels, nerves, ureters, and bone
• Trunk, where surgical removal of the tumor often requires reconstruction of the abdominal or chest wall
• The use of multiple options to treat sarcoma has allowed surgeons to alter the operative approach to these tumors. Our surgeons helped develop several approaches to the treatment of these cancers, and are national leaders in performing these procedures, including:
• Limb-sparing surgery, which we helped pioneer and remain committed to advancing; today, only 5 percent of cancers occurring in the limbs require amputation
• Minimally invasive techniques to treat tumors of the abdomen, bowel, and other areas
• Plastic surgery performed by surgeons who specialize in correcting and repairing tissues damaged by sarcomas and their surgical removal

Pioneering Radiation TherapyOur program is one of the largest and most specialized centers for sarcoma treatment. Adding significantly to this expertise are the radiation oncologists who specialize in treating sarcomas and connective tissue cancers.

Among the radiation oncology approaches offered here are:

• Proton beam radiation, which delivers a high dose of radiation precisely to the tumor site while minimizing radiation to adjacent normal tissue, which may result in less radiation damage to surrounding tissues; our program has extensive experience using proton beam radiation to treat sarcomas of the skull base, spine, and pelvis
•  Intra-operative radiation therapy, we remain one of the few centers in the country to offer this form of radiation during surgery to treat abdominal sarcomas
• Brachytherapy, in which catheters (tubes) are placed into the tumor bed, generally at the time of surgical removal, to allow the temporary placement of radioactive seeds, which are delivered directly into the sarcoma site

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