Radiation therapy is a common additional local treatment beyond surgery for soft-tissue sarcoma patients. Many patients with after surgery alone have a highher risk of relapse in a local area, and radiation is often used prior to surgery to sterilize the cells surrounding the tumor, so when the surgeon operates he or she is less likely to cut through cancerous cells to remove the tumor. Generally at Johns Hopkins, radiation is the first stage of therapy and surgery follows.
The advantages to this method are that radiation oncologists can use a smaller dose of radiation can be given to a smaller area. This can reduce side effects like scarring, stiffness or swelling of a limb. One caveat to performing radiation first is that wound problems may be worse in radiated tissues that need to be surgically removed. For this reason, plastic surgeons are often included in the surgical team to reconstruct defects in the remaining tissues of soft-tissue sarcoma patients after surgical resection of the tumor.
Dr. Deborah Frassica discusses radiation therapy for soft-tissue sarcomas
The experienced radiation oncologists at Johns Hopkins specialize in treating all types of cancer with a variety of radiation therapies. As part of a larger multidisciplinary team, they help create an individualized radiation therapy plan for each patient’s specific needs. They are among few physicians offering brachytherapy and intra-operative radiation therapy.
Types of radiation therapy
Our radiation oncologists specialize in a variety of techniques including:
- External beam radiation therapy – This delivers a beam of high-energy X-rays to a patient’s tumor site to destroy the cancer cells. External beam radiation gets its name from the fact that the beams come from an external source (a machine called a linear accelerator) and are aimed at the site of the tumor.
- Intensity-modulated radiation therapy (IMRT) – This is a type of external beam radiation that uses computer-controlled radiation beams in conjunction with three-dimensional computed tomography images of the tumor site and surrounding area. IMRT delivers targeted radiation doses to the tumor site, patterned to match the shape of the tumor through modulating the intensity of the radiation beams. This technology not only means that the tumor site receives the high doses needed to destroy cancer cells, it also spares surrounding organs and tissue.
- Image-guided radiation therapy (IGRT) – This uses frequent imaging to provide images of the cancer site. Being able to see the site provides highly precise and accurate delivery of the radiation. The radiation oncologist can create and view images of the tumor site before and during the time the radiation is delivered. IGRT is especially useful for cancer sites in parts of the body that move (such as the lungs) or for sites near major organs and tissues that should not receive radiation (like the heart or kidneys).
- Stereotactic body radiation therapy (SBRT) – This precise radiation treatment delivers high doses of radiation at the same time that it spares nearby tissues and organs. Despite its name, it is a non-surgical radiation therapy that can be used as an alternative to invasive surgery. Stereotactic radiosurgery technology delivers radiation beams from different angles and planes. Before the treatment is delivered, the radiation oncologist and treatment team use three-dimensional imaging to determine the exact coordinates of the tumor. In some cases, they may also use image-guided radiation therapy (IGRT) to confirm the location of the tumor before and/or during the radiation treatment. Its biggest benefits over conventional therapy are that it can treat very small tumors or those located in hard-to-reach places, and treatment times are much shorter.
- Radio immunotherapy – This technique combines a radioactive substance with an antibody that is injected/infused into the body. The antibody targets, and sometimes reacts with, proteins on cancer cells called antigens; then the radioactive molecule destroys the cells. The therapy has a less toxic effect on normal tissues than chemotherapy does and offers a brief recovery period.
- Brachytherapy - This is a targeted high-dose radiation treatment that can be delivered via radioactive "seeds" or wires that are placed directly in or near the tumor or via an applicator device placed at the tumor site. The biggest benefit is that it delivers a high dose of radiation directly to the tumor and reduces damage to surrounding healthy tissue.
- High-dose intra-operative radiation therapy (HD-IORT) – This provides an intensive, targeted dose of radiation to a tumor site after the tumor is surgically removed to sterilize the area where the tumor was located. IORT is often given after standard radiation therapy and has been shown to decrease the chance of the cancer coming back or recurring. HDR-IORT is particularly effective at treating recurrent tumors as well as large tumors that adhere to normal tissues. It can also be used to target tumors in places that would be hard to reach with other radiation treatments.
Because it requires both expertise and special equipment, Johns Hopkins is one of the few centers that offers this treatment. Its benefits include:
- Immediate radiation treatment
- Precisely targeted to the site so that surrounding healthy tissues and organs are not damaged
- Possibly fewer side effects than traditional external beam radiation treatment
More information on radiation can be found at The Johns Hopkins Kimmel Cancer Center's Molecular and Radiation Sciences.