Understanding Sarcoma

How is Sarcoma Treated?

Last updated and reviewed on May 27, 2026.

Treatment for sarcoma depends on several things: the type and subtype of sarcoma, where it is located, its stage and grade, your age, and your overall health. Because there are so many different types of sarcoma, treatment plans vary a lot from person to person. Your care team will likely include specialists such as a surgical oncologist (or orthopedic oncologist for bone sarcomas), a medical oncologist, a radiation oncologist, and a pathologist, all ideally with experience in sarcoma.

Surgery

Surgery is the main treatment for most sarcomas. The goal is to remove the entire tumor along with a margin of healthy tissue around it (called a clear margin or negative margin), so that no cancer cells are left behind.

• Wide local excision (limb-sparing surgery): For most soft tissue sarcomas in the arms or legs, surgeons aim to remove the tumor while saving the limb. This is called limb-sparing surgery or limb-salvage surgery. It was not always possible in the past, but with modern surgical techniques, most patients do not need amputation.

• Amputation: In a small number of cases, usually when the tumor surrounds major blood vessels or nerves and cannot be safely removed otherwise, amputation of the limb may be needed. Advances in prosthetics and rehabilitation have greatly improved the quality of life for patients who require amputation.

• Resection of retroperitoneal or abdominal sarcomas: For sarcomas in the abdomen or behind it (retroperitoneum), surgery can be very complex. The tumor may be large and close to important organs. At specialized centers, surgeons may remove the tumor along with parts of nearby organs to achieve clear margins.

• Surgery for bone sarcomas: The approach depends on the bone and the tumor's size. For many osteosarcomas near the knee, a bone segment is removed and replaced with a metal implant (endoprosthesis) or a bone graft. This is called a bone-sparing or limb-salvage procedure.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells throughout the body. Not all sarcomas respond equally well to chemotherapy. It is most commonly used for:

• High-grade soft tissue sarcomas: Chemotherapy is sometimes given before surgery (neoadjuvant chemotherapy) to shrink the tumor, or after surgery (adjuvant chemotherapy) to lower the risk of the cancer coming back.

• Bone sarcomas (osteosarcoma and Ewing sarcoma): Chemotherapy is a central part of treatment for these cancers. For osteosarcoma, a standard regimen includes drugs like cisplatin, doxorubicin, and methotrexate. For Ewing sarcoma, drugs like vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide are typically used.

• Rhabdomyosarcoma: Like Ewing sarcoma, rhabdomyosarcoma is treated with a combination of chemotherapy, surgery, and sometimes radiation.

• Advanced or metastatic sarcoma: Chemotherapy is used to try to shrink tumors and slow the disease. Common first-line drugs for adult soft tissue sarcomas include doxorubicin (alone or in combination with ifosfamide).

Radiation Therapy

Radiation therapy uses high-energy beams to kill cancer cells. In sarcoma treatment, it is most often used alongside surgery:

• Before surgery (preoperative radiation): Radiation can shrink the tumor, making it easier to remove with clear margins.

• After surgery (postoperative radiation): Radiation can kill any remaining cancer cells and reduce the risk of local recurrence (the cancer coming back in the same area).

• For unresectable tumors: If a sarcoma cannot be safely removed with surgery, radiation may be used as the primary treatment to control the tumor.

Advanced techniques like intensity-modulated radiation therapy (IMRT) and proton beam therapy allow doctors to deliver high doses of radiation precisely to the tumor while protecting nearby healthy tissue.

Targeted Therapy

Targeted therapies are drugs that specifically attack features that are unique to certain cancer cells. They tend to have different and sometimes fewer side effects compared to standard chemotherapy. Several targeted therapies are approved or used for specific sarcoma subtypes:

• Imatinib (Gleevec): Targets the abnormal KIT or PDGFRA proteins found in most gastrointestinal stromal tumors (GISTs). Imatinib was a revolutionary advance in GIST treatment and is typically the first treatment given.

• Sunitinib and regorafenib: Used for GISTs that stop responding to imatinib.

• Pazopanib: An anti-angiogenic drug (blocks blood vessel growth) approved for certain advanced soft tissue sarcomas.

• Trabectedin: Approved for certain types of liposarcoma and leiomyosarcoma.

• Eribulin: Approved for liposarcoma.

• Olaratumab (in combination with doxorubicin): Was used for soft tissue sarcomas; ongoing research continues to explore combination approaches.

• ALK inhibitors (crizotinib, ceritinib): For inflammatory myofibroblastic tumors (IMTs) with ALK gene rearrangements.

• TRK inhibitors (larotrectinib, entrectinib): For sarcomas with NTRK gene fusions.

Immunotherapy

Immunotherapy uses medicines to help your immune system recognize and attack cancer cells. Research in immunotherapy for sarcoma is growing. Currently, checkpoint inhibitors (like pembrolizumab) have shown activity in some sarcoma subtypes, particularly alveolar soft part sarcoma and undifferentiated pleomorphic sarcoma. Clinical trials are actively exploring new immunotherapy approaches for sarcoma.

Supportive Care

Supportive care (also called palliative care) is an important part of treatment for sarcoma at every stage. It focuses on relieving pain and other symptoms, managing treatment side effects, and supporting emotional well-being. Supportive care does not mean giving up on treatment; it is given alongside active treatments to help you feel as well as possible throughout your care.

A supportive care team may include social workers, pain specialists, dietitians, physical therapists, and mental health counselors. Early involvement of palliative care alongside active cancer treatment has been shown to improve quality of life and, in some studies, even survival.

Follow-Up Care After Treatment

After completing treatment, regular follow-up visits are essential. Sarcoma can come back, and early detection of recurrence gives the best chance of successful retreatment. Follow-up typically includes physical exams, imaging (usually CT scans of the chest to check for lung metastases), and MRI or CT of the original tumor site. Your doctor will give you a specific follow-up schedule based on your type and stage of sarcoma.

Sources

1. National Cancer Institute. Soft Tissue Sarcoma Treatment (PDQ) – Patient Version. https://www.cancer.gov/types/soft-tissue-sarcoma/patient/adult-soft-tissue-treatment-pdq

2. von Mehren M, et al. NCCN Clinical Practice Guidelines in Oncology: Soft Tissue Sarcoma. Journal of the National Comprehensive Cancer Network. 2022. https://jnccn.org/view/journals/jnccn/20/7/article-p815.xml

3. American Cancer Society. Treating Soft Tissue Sarcoma. https://www.cancer.org/cancer/types/soft-tissue-sarcoma/treating.html

4. Demetri GD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. New England Journal of Medicine. 2002;347(7):472–480. https://www.nejm.org/doi/full/10.1056/NEJMoa020461

5. Judson I, et al. Doxorubicin alone versus intensified doxorubicin plus ifosfamide for first-line treatment of advanced or metastatic soft-tissue sarcoma. Lancet Oncology. 2014. https://www.sciencedirect.com/science/article/pii/S1470204514700634