Recurrence can refer to recurrence at the local site where the sarcoma first appeared or it can mean recurrence at another site (a metastasis), meaning that the tumor has spread. Because recurrence is a definite risk for some patients, many sarcoma survivors are understandably anxious about the possibility.
At Memorial Sloan-Kettering, management of recurrence is determined based on the benefits, risks, and potential side effects of the various treatment regimens as they relate to each individual patient. First, a physician generally performs an extent of disease workup to ascertain the precise stage of the recurring sarcoma. The workup may include x-rays of the area of recurrence and chest x-rays, as well as CT and MRI scans. Given the same information, two different people may make different but equally valid decisions regarding options for management of recurrence.
For surveillance during follow-up, PET/CT (positron-emittance tomography and computed tomography) is now often a combined study. Combination PET/CT shows both location and the metabolic signal of actively growing cancer cells if a tumor should arise. If the PET/CT study indicates a recurrence, your doctor may order a separate CT study for precise information about the location of the tumor.
Soft tissue sarcoma is a treatable cancer, even when it recurs locally. Recurrence does not necessarily mean that the first treatment was wrong or inadequate, and it doesn’t mean that the person with the recurrence cannot be cured. Local recurrence, in particular, is rarely a factor causing death from sarcoma.
Patients with an isolated local recurrence generally have another operation (re-resection). Results of re-resection are often good; the majority of patients have long-term survival. Many patients with local recurrence also receive adjuvant (additional) radiation therapy with surgery. The radiotherapy approach depends on the method and extent of previous surgery and radiotherapy, and may include brachytherapy or external beam radiation.
Distant Recurrence & Metastasis
Options for treatment of recurrences in organs and parts of the body other than the original site depend on several factors, including the following:
- the kind of treatment the patient had before (if any)
- whether the sarcoma has spread to several locations in the body or is confined to a single organ
- the severity of symptoms (if any)
Depending on individual factors, treatment may include surgery to remove the cancer (metastasectomy) with or without adjuvant radiation therapy, and in some instances chemotherapy alone.
Adjuvant & Investigational Approaches to Preventing Recurrence
Patients with high-grade primary tumors or larger tumors (greater than 5 centimeters) may receive adjuvant radiation therapy, and in some instances chemotherapy, as part of their initial treatment to reduce their risk for local recurrence and metastasis.
Memorial Sloan-Kettering researchers are evaluating a number of new medications for the treatment of sarcoma survivors who have recurrences. Such investigational therapies are offered to eligible patients through clinical trials. Some of these studies do not permit patient with metastatic disease who have received previous treatments with chemotherapy to participate. Other studies allow patients who have been treated with chemotherapy to participate.
For up-to-date details about current clinical trials at Memorial Sloan-Kettering Cancer Center, please visit our clinical trial database.