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UW Medical Center's Sarcoma Service is the oldest multidisciplinary oncology program at the university. Its expertise is now combined with the Seattle Cancer Care Alliance, a partnership between the Fred Hutchinson Cancer Research Center, the University of Washington, and Children’s Hospital and Regional Medical Center.
Unique to the Sarcoma Service is its close relationship with the Northwest Tissue Center, one of the largest accredited tissue banks in North America. It’s the only tissue bank in the world that combines the resources of a major university medical center with a regional organ-procurement agency and a large nonprofit blood center.
The Sarcoma Service provides leading-edge therapies and treatments for diseases, including bone and metallic transplants. In 2001, a $650,000 three-year grant was awarded to the UW Sarcoma Service to build new knee implants for tumor patients.
Sarcoma Radiation Therapy
Sarcomas are malignant tumors of soft tissue or bone that arise in muscle, fat, blood vessels, connective tissue, and bones. Most are treated with surgery and many patients require radiation and chemotherapy.
The University of Washington, Seattle Cancer Care Alliance, and Children's Hospital and Regional Medical Center offer a multidisciplinary approach to the treatment of sarcomas of all kinds. Patients who require radiation therapy generally have this treatment at UW Medical Center's Cancer Center.
Surgery is the best option for removing malignant tumors. However, after surgery, small deposits of malignant cells remain in the area and would lead to recurrence of tumor if left untreated in many patients. Therefore, radiation therapy is recommended to selected patients. There are several methods of radiation therapy that are offered here:
Standard Types of Radiation Therapy
Two widely accepted types of radiation therapy for sarcomas are conventional external beam radiation therapy and brachytherapy. In randomized trials, both of these appear effective and prevent the tumor from recurring in the surgical area.
Conventional External Beam: After healing from surgery and after any chemotherapy is completed, patients undergo a series of daily radiation treatments to the affected area. These are given Monday through Friday for approximately 7 weeks. The treatments are about 15-20 minutes per day. This is the most widely used type of radiation for soft tissue sarcomas.
Brachytherapy: Patients with sarcomas of the trunk or limbs may be eligible for a shorter course of radiation therapy. During the surgery to remove the tumor, the radiation oncologist places hollow plastic catheters spaced evenly over the bed of where the tumor was removed. These catheters exit through small holes in the skin separate from the main surgical scar. Approximately 5 days after surgery, radiation treatments are begun by using a high intensity Iridium-192 source threaded through the catheters. Two 30 minute treatments are given each day for 5 days. The catheters are then removed. The advantage of this procedure is the shorter overall treatment time and the smaller volume of normal tissue that gets irradiated. The disadvantage is a potential problem with wound healing after surgery.
Neutron Beam Therapy: is a type of radiation treatment that is more effective for certain types of cancer than conventional radiation. The UWMC Cancer Center is one of only two centers in the country that performs this specialized treatment.
Sarcoma patients with visible disease left behind after surgery, patients with unresectable disease, and patients with chondrosarcoma or osteogenic sarcoma with a high risk of local recurrence are all considered for this treatment. Neutron therapy requires approximately 4-5 weeks of treatment given 4 days per week. We recently reviewed our series of high-risk patients treated for sarcomas of soft tissues or bone and have found that approximately 60 percent of patients have long term control of tumor in the area treated with neutrons.
Intraoperative Radiation Therapy (IORT): After surgical removal, patients with tumors deep within the abdomen or chest may require radiation given directly to the bed of the tumor for optimal control. This is because these tumors are frequently adherent to normal structures that cannot themselves be removed and have a high risk of recurrence in that area.
Following removal of the tumor, the patient is transported while asleep to the Cancer Center and receives a focused beam of electron radiation directly to the area at risk. The patient is then returned to the operating room and the surgery is completed as planned.
There are a number of studies that show that IORT when combined with additional external radiation effectively reduces the risk of tumor recurrence in appropriate patients.
The science research program associated with the Sarcoma Service collaborates with scientists located primarily within the UW department of orthopaedics. There are multiple genetic and molecular oncology studies currently in progress including several prospective clinical studies for imaging high-grade malignancies and a comprehensive skeletal transplant immunology project.