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Physician Update - Tough on soft-tissue sarcoma

Physician Update Summer 2011

Tough on soft-tissue sarcoma

Date: July 1, 2011

The best treatment approach, says Deborah Frassica, is to sterilize the cells around the mass with radiation therapy before the tumor is removed.

Of all the patients that Deborah Frassica has treated for soft-tissue sarcoma in recent years, the preacher would have to rank near the top when it came to demonstrating gratitude: He made his medical saga—and Johns Hopkins’ healing of his condition—the stuff of one of his finest sermons.

But even if word of the treatment provided by Hopkins’ musculoskeletal oncology group isn’talways spread like gospel, they handled nearly 50 cases of these rare tumors last year, says Frassica, a radiation oncologist who specializes in the lesions and knows they’re hard to spot in general practice.

The tumors associated with soft-tissue sarcoma do not seem to choose their prey based on gender or race. They usually present as a painless lump, often in the thigh or buttock or groin area, and many practitioners are inclined toward quick surgical removal. But hasty resection can also cause problems if it’s done before physicians know whether the tumor is cancerous or not.

“This can create difficulties in subsequent management,” says Frassica. “It can make us change how we would normally do things.” For instance, “if a lump has been scooped out, that can spread tumor in the local area, and then the patient requires a bigger surgical procedure,” she explains. In addition, higher doses of radiation may also be necessary, and there’s a possible increased risk that the cancer could subsequently recur.

Still, Frassica understands why the tumors pose a treatment dilemma. “Lots of people have lumps,” she says, “and most of the time they’re not anything but benign fatty tumor.” The time to worry is when a lump is new or is growing. In those cases, Frassica recommends, the tumor should be evaluated with magnetic resonance imaging, which she says “can tell us quite confidently if something is or isn’t a benign fatty tumor.”

If the tumor is suspicious, says Frassica, the patient should be seen by sarcoma experts and a biopsy of the mass should be done. “That allows us to plan the best way to approach the mass,” she says, “and have the best chance at a good outcome.”

About a dozen such cases are presented every Wednesday at Hopkins to a multidisciplinary tumor conference focused on musculoskeletal oncology. The 20-physician group includes three orthopedic oncologists, a neurosurgeon, a surgical oncologist, two radiation oncologists, adult and pediatric medical oncologists, radiologists and two pathologists specializing in bone and soft tissue.

In their growing patient population, says Frassica, early-stage patients are usually 100 percent curable. In more advanced tumor cases, patients may require escalating levels of chemotherapy, radiation and surgery. But even then, says Frassica, about 85 percent of patients are still alive five years out.

 410-502-8000 to refer a patient.

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