About radiotherapy for soft tissue sarcoma

Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells.

Radiotherapy is an important part of treatment for soft tissue sarcomas.

It can be given in different ways:

  • It can be given after surgery (adjuvant treatment), to destroy any remaining cancer cells and reduce the risk of the cancer coming back. The wound must be healed before radiotherapy starts.
  • It can be given before surgery (neo-adjuvant treatment), either to shrink the tumour and make it easier for the surgeon to remove it successfully, or to avoid having to amputate the limb.
  • It can be given to help relieve symptoms and control a sarcoma that has come back after treatment or spread to another part of the body and cannot be removed. This is called palliative radiotherapy and may help improve your quality of life.
  • Rarely, radiotherapy is given on its own and may be the only treatment needed.

How radiotherapy is given

Radiotherapy for soft tissue sarcoma can be given in different ways.

  • Intensity-modulated radiation therapy (IMRT)

    This type of radiotherapy is often used to treat sarcomas. IMRT gives the tumour a high dose of radiation and changes the dose given to nearby healthy tissue. This can help reduce side effects. We have more information about IMRT on our external beam radiotherapy page.

  • Intraoperative radiation therapy (IORT)

    This type of radiotherapy is given from inside the body (internally) during surgery. After removing the cancer, the doctor gives the same area a single dose of radiotherapy. They give the radiotherapy from a special machine. Some people may also have another type of radiation after surgery. IORT is not suitable for everyone and is not widely available on the NHS.

  • Stereotactic radiotherapy

    This is a new way of giving radiotherapy that may sometimes be used to treat small soft tissue sarcomas. Stereotactic radiotherapy treatment is given using a specially adapted radiotherapy machine. It gives beams of radiotherapy from many different angles. The beams overlap at the tumour. This gives the tumour a very high dose of radiotherapy, and surrounding tissues only get a very small dose. Stereotactic radiotherapy is not available in all hospitals in the UK. Your specialist can give you more information if this is an option for you.

  • Brachytherapy

    Brachytherapy is when doctors treat the cancer by inserting radioactive material directly into the affected area. A high dose of radiation is given to the tumour, but healthy tissue only gets a small amount of radiation. Brachytherapy is not commonly used to treat soft tissue sarcomas. Your specialist can discuss brachytherapy and its side effects with you if they think it will be helpful.

  • Proton beam therapy

    Proton beam therapy uses proton radiation rather than x-rays to destroy cancer cells. The proton beam is aimed directly at the cancer, so it causes very little damage to nearby healthy tissue. Proton beam therapy is sometimes used to treat sarcomas in children and sarcomas in adults that are very close to important structures, such as the spine. We have more information about proton beam therapy.

Planning your radiotherapy

Before you start your treatment, it needs to be planned. This is to make sure the radiotherapy is aimed precisely at the cancer. This also means it causes the least possible damage to the surrounding tissue.

Radiotherapy is planned by your clinical oncologist and the radiotherapy team. Planning is important and may take a few visits. For soft tissue sarcoma, planning may involve:

  • Radiotherapy masks and moulds

    If the sarcoma is in a limb or the head and neck area, you may need to have a radiotherapy mask or mould made. This helps keep your head or limb still during radiotherapy treatment sessions. It is made in the mould room on your first visit to the radiotherapy department. Your doctor or specialist nurse will tell you more about moulds if you need one.

    You do not usually need a mask or mould if you are having radiotherapy to the chest, tummy area (abdomen) or pelvis. You will be supported with shaped pillows to help keep you still during treatment.

  • Skin markings

    To help the radiographers position you accurately for the treatment, they may make marks on your mould or mask. If you do not have a mould or mask, they will draw the marks on your skin. These marks must stay throughout your treatment, but they can be washed off when your course of treatment finishes. Often, very small permanent markings are made on the skin (tattoos). They will only be done with your permission. It is a little uncomfortable while the tattoo is being made.

As part of the planning, you will have a CT scan of the area to be treated. This helps plan the precise area for your radiotherapy. This session usually takes about 30 minutes.

You may also need to have an MRI scan. This uses magnetism to build up a detailed picture of part of the body. It can give extra useful information.

The information from the scans is fed into the radiotherapy planning computer. The computer precisely designs your individual treatment plan.

Having radiotherapy for soft tissue sarcoma

Radiotherapy is normally given as a series of short, daily treatments in the hospital radiotherapy department.

The treatments are usually given from Monday to Friday. The number of treatments you have depends on the type, size and position of the area to be treated. A course of treatment for an early-stage cancer usually lasts about 6 weeks. Each treatment takes about 10 to 15 minutes. Your doctor will talk to you about the treatment and possible side effects.

At the beginning of each session of radiotherapy, the radiographer will explain what to expect. They will position you carefully on the treatment couch as you were during the planning session. When you are in the correct position, the radiographers will leave the room and you will be given your treatment. Radiotherapy is not painful, but you will have to lie still for a few minutes during the treatment.

The radiographers will be able to see and hear you during your treatment.

Side effects of radiotherapy for soft tissue sarcoma

You may develop side effects during your treatment. These side effects will usually disappear over a few weeks or months after treatment is finished.

Your doctor, nurse or radiographer will discuss this with you, so you know what to expect. Let them know about any side effects you have during or after treatment. There are often things that can be done to help.

Hair loss

You may lose hair from the area being treated by radiotherapy. Treatment for soft tissue sarcomas will not make all the hair on your head fall out. The hair may grow back after the treatment has ended, but the hair loss is often permanent.

Skin care

You may find your skin in the treatment area becomes red or darkens. It may also feel sore or itchy. Sometimes the skin gets very sore, and it may blister, break or leak fluid. Very rarely, your doctor may stop your treatment for a short time to allow a serious skin reaction to recover.

Skin reactions can take time to improve. They are usually better about 4 weeks after you finish treatment. In the longer term, the area of skin may look or feel slightly different to the surrounding skin.

Your radiographers or nurses will give you advice on how to look after your skin during and after treatment.

Tiredness (fatigue)

Tiredness is a common side effect and may continue for months after treatment finishes. During treatment, you may need to rest more than usual, especially if you have to travel a long way for treatment each day. But it is good to do gentle exercise, such as walking, when you feel able to. This can help boost energy and improve your general well-being.

When your treatment has finished, slowly increase your activity and try to balance rest periods with some physical activity. This will help you build up your energy levels.

Feeling sick (nausea)

Some people find their treatment makes them feel sick (nausea) and sometimes be sick (vomit). This is most common when the treatment area is near the tummy area and pelvis.

If you have nausea and vomiting, this can usually be effectively treated with anti-sickness drugs (anti-emetics). Your doctor can prescribe these for you.

If you do not feel like eating, you can replace meals with nutritious, high-calorie drinks. These are available from most chemists and can be prescribed by your GP. It is important to keep drinking water, so you do not become dehydrated.

It can help to sip drinks slowly if you feel sick. It is important to eat and drink well during treatment to help you cope with and recover from the radiotherapy.

Long term side effects of radiotherapy

Some people may have long-term or late effects of radiotherapy. These can develop months or sometimes years after treatment. Always let your cancer doctor or specialist nurse know if you have any new symptoms or problems after treatment.

Late effects of radiotherapy for soft tissue sarcoma may include:

  • Lymphoedema

    After radiotherapy, some people may develop swelling called lymphoedema. It happens because the lymph nodes and vessels can be damaged by surgery or radiotherapy. This means lymph fluid, which circulates around the lymphatic system, cannot pass along the vessels. It builds up, which causes swelling. If lymphoedema develops, it cannot be cured, but it can often be treated and managed.

  • Stiff joints

    Radiotherapy to a joint, such as the knee or elbow, may cause it to become stiff. It is important to keep the joint mobile by using it and doing regular exercise. A physiotherapist will give you some exercises to do before, during and after treatment to help prevent stiffness.

  • Bone changes

    Radiotherapy to a limb can increase the risk of a fracture in any bones in the treatment area. This is rare and most people who have radiotherapy will not have any bone problems.

    If you have pain or aching in the bones, always let your cancer doctor or nurse know. It can be caused by a number of conditions, but it is very important to get it checked.

  • Second cancer

    A small number of people will develop a second cancer because of the radiotherapy treatment they have had. But the chance of a second cancer developing is so small that the risks of having radiotherapy are much smaller than the benefits.

    You can talk to your cancer specialist if you are worried about your risk of developing a second cancer.