Soft Tissue Cancer
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- Last Updated: May 30, 2017
Background
Malignant soft tissue tumors, also called sarcomas, are cancers that begin in the muscle, fat, fibrous tissue, blood vessels, or other supporting tissue in the body. There are over 50 different types of soft tissue sarcomas. They are often found in the arms, legs, head and neck, or abdomen and occur more commonly in adolescents and young adults. Soft tissue sarcomas account for more than 11,400 new diagnoses and 4,300 deaths each year.
Intermediate grade soft tissue tumors have features in between sarcomas and benign tumors. They are often locally aggressive and rarely spread to distant sites. Desmoid tumors, also called desmoid fibromatosis, are one example of this category. These lesions usually grow slowly but are difficult to treat as they are locally invasive, preventing surgical resection without significant morbidity. Even in cases where the tumors are considered to be completely resected, there is a high recurrence rate. Radiation and systemic medical therapy is often used to treat these tumors, but these treatments are not highly effective and may result in local and systemic side effects.Treatment
Surgery is the most common treatment for soft tissue sarcomas. In some cases, radiation or chemotherapy might be used to shrink the tumor before surgery or kill any tumor cells left behind after surgery. Lymph nodes, although typically not a site of sarcoma spread, also might be removed and checked for signs of cancer. The exact treatment regimen depends on the size and stage of the sarcoma.Soft tissue sarcomas may recur after surgery. In such cases, surgery is used again to remove the tumor. In rare cases, amputation is needed.
Immunotherapy uses the immune system to fight disease and is currently being investigated in the treatment of sarcomas.
Focused Ultrasound
Focused ultrasound may offer a noninvasive way to destroy soft tissue sarcomas. Using imaging guidance, the physician directs a focused beam of acoustic energy toward the tumor. This energy heats and kills tumor cells without damaging surrounding tissue. As a non-invasive procedure, focused ultrasound might offer the following benefits:- It offers shorter recovery time with fewer complications.
- Because it does not use ionizing radiation, it can be repeated as often as needed.
- Patients can avoid the long-term effects of radiation or chemotherapy.
- Can be used in locations that are difficult or impossible to access with conventional surgery
Surgery, chemotherapy and/or radiation remain the standard of care for soft tissue sarcomas, and offer the only proven methods of achieving cure. However, for some locally aggressive tumors such as desmoids, the same methods used to treat sarcomas may cause too much morbidity. In these tumors, which do not metastasize, it would be valuable to have a means of achieving local control of tumor growth with causing minimal side effects. A recent article states that MRgFUS may be a feasible treatment option for desmoid tumors as 4/5 patients that had 1 year follow up had a decrease in size of their tumors. A more recent publication reports the results of a multicenter study in which 15 patients with desmoid tumors were successfully treated using MR guided focused ultrasound. Several cases of soft tissue sarcomas have also been treated with MRgFUS with success and thus MRgFUS may prove helpful in the treatment of sarcomas where there are limited treatment options or there is recurrence. In one patient, focused ultrasound was used to treat a patient with a recurrent synovial sarcoma.
Clinical Trials
A clinical trial is currently enrolling patients at Stanford University, exploring the feasibility of focused ultrasound for the ablation of soft tissue tumors (benign and malignant) of the extremities. To inquire about treatment in this trial, contact Raffi Avedian, MD at 650-721 7618 or or Pejman Ghanouni, MD, PhD at 650-498-4485 or .
A clinical trial at Children’s National Medical Center is looking at a wide range of relapsed or refractory soft tissue cancers that are in children. These tumors are treated with focused ultrasound and then lyso-thermosensitive liposomal doxorubicin. To inquire about treatment in this trial, contact Stephanie A Forlenza, at 202-476-6841 or .
See a list of all clinical trials here
Treatment Sites
Please see a list of treatment sites hereRegulatory & Reimbursement
The Model JC Haifu system has received regulatory approval in Europe for treatment of soft tissue tumors, including sarcomas. At present, focused ultrasound is not universally reimbursed for treatment of soft tissue sarcomas.Patient Advocacy
Several organizations worldwide support patients with soft tissue sarcomas. Among them are:Sarcoma Alliance, which works to improve the lives of patients affected by sarcomas through better diagnostic accuracy, improved access to care, education, and support. For more information, visit www.sarcomaalliance.org.
Sarcoma Patients Euronet, which works with clinical experts, research scientists, industry, and others to improve treatment and care for sarcoma patients in Europe by increasing awareness and providing patients with support and information. For more information, visit www.sarcoma-patients.eu.
Notable Papers
Ghanouni P, Dobrotwir A, Bazzocchi A, Bucknor M, Bitton R, Rosenberg J, Telischak K, Busacca M, Ferrari S, Albisinni U, Walters S, Gold G, Ganjoo K, Napoli A, Pauly KB, Avedian R. Magnetic resonance-guided focused ultrasound treatment of extra-abdominal desmoid tumors: a retrospective multicenter study. Eur Radiol. 2017 Feb;27(2):732-740. doi: 10.1007/s00330-016-4376-5.
Shim J, Staruch RM, Koral K, Xie XJ, Chopra R, Laetsch TW. Pediatric Sarcomas Are Targetable by MR-Guided High Intensity Focused Ultrasound (MR-HIFU): Anatomical Distribution and Radiological Characteristics. Pediatr Blood Cancer. 2016 Oct;63(10):1753-60. doi: 10.1002/pbc.26079.
Endo Y. CORR Insights(®): Is MR-guided High-intensity Focused Ultrasound a Feasible Treatment Modality for Desmoid Tumors? Clin Orthop Relat Res. 2016 Mar;474(3):705-6. doi: 10.1007/s11999-015-4427-2. No abstract available.
Avedian R, Bitton R, Gold G, Butts-Pauly K, Ghanouni P. Is MR-guided High-intensity Focused Ultrasound a Feasible Treatment Modality for Desmoid Tumors? Clin Orthop Relat Res and Related Research. 2016 Mar;474(3):697-704. doi: 10.1007/s11999-015-4364-0. A Publication of The Association of Bone and Joint Surgeons
Ghanouni P, Butts Pauly K, Bitton R, Avedian R, Bucknor M,Gold G. MR guided focused ultrasound treatment of soft tissue tumors of the extremities — preliminary experience. J Ther Ultrasound. 2015; 3(Suppl 1): O69.
de Smet M, Hijnen NM, Langereis S, Elevelt A, Heijman E, Dubois L, Lambin P, Grüll H. Magnetic resonance guided high-intensity focused ultrasound mediated hyperthermia improves the intratumoral distribution of temperature-sensitive liposomal doxorubicin. Invest Radiol. 2013 Jun;48(6):395-405. doi: 10.1097/RLI.0b013e3182806940.
Hu X, Cai H, Zhou M, He H, Tian W, Hu Y, Chen L, Deng Y. New clinical application of high-intensity focused ultrasound: local control of synovial sarcoma. World J Surg Oncol 2013;11:265.
Keshavarzi A, Vaezy S, Nobel ML, Chi EY, Walker C, Martin RW, Fujimoto VY. Treatment of uterine leiomyosarcoma in a xenograft nude mouse model using high-intensity focused ultrasound: a potential treatment modality for recurrent pelvic disease. Gynecol Oncol 2002;86:344-50.
Click here for additional references from PubMed.
