Question: My brother is 24 years old. A tumor was found in his leg. The result of the biopsy taken from here came as soft tissue sarcoma. In the scans, it was determined that the cancer had spread to three places in the right lung and two places in the left lung. There was no metastasis elsewhere. Doctors give conflicting advice on treatment. While some immediately recommend chemotherapy, some doctors say that my father should have surgery. We are surprised. What way would you suggest?
Answer: In oncology, the treatment for metastasized cancers is usually chemotherapy, although there are exceptions to this. These include colon cancer, male and female ovarian cancers, kidney cancer, and bone tumors. Surgical removal of metastases along with chemotherapy may also be considered in eligible patients with such cancers. Malignant tumors originating from soft tissues should also be evaluated in this group. Surgery is generally applied in cases where there is a small number of metastases and no deterioration in organ functions is expected as a result of their removal. Surgical removal of soft tissue sarcomas, especially in patients with lung metastases, is among the leading treatment options. Even in patients with multiple lung metastases, surgery may be considered.
Although there are different approaches to your brother’s tumor, my opinion is that both chemotherapy and surgery should be applied together. Because in a young patient like your brother, complete eradication of the sarcoma can only be possible with such an aggressive treatment. For this, if the tumor in the leg is large, a few cycles of chemotherapy should be applied first. After the original tumor has shrunk, it must be surgically removed. The chemotherapy given is expected to be effective not only on the tumor in the leg but also on metastases in the lung. To understand how effective the treatment is, lung metastases should be re-evaluated with tomography or PET-CT. If non-disappearing metastases are detected, these should also be surgically removed. In addition to all these treatments, radiation therapy to the original tumor bed in the leg may also be considered.
Your sibling’s illness is a condition that must be decided together by the medical oncologist, radiation oncologist, and surgeons. Even this case demonstrates the importance of tumor boards with doctors from different branches in oncology.
Answer: In oncology, the treatment for metastasized cancers is usually chemotherapy, although there are exceptions to this. These include colon cancer, male and female ovarian cancers, kidney cancer, and bone tumors. Surgical removal of metastases along with chemotherapy may also be considered in eligible patients with such cancers. Malignant tumors originating from soft tissues should also be evaluated in this group. Surgery is generally applied in cases where there is a small number of metastases and no deterioration in organ functions is expected as a result of their removal. Surgical removal of soft tissue sarcomas, especially in patients with lung metastases, is among the leading treatment options. Even in patients with multiple lung metastases, surgery may be considered.
Although there are different approaches to your brother’s tumor, my opinion is that both chemotherapy and surgery should be applied together. Because in a young patient like your brother, complete eradication of the sarcoma can only be possible with such an aggressive treatment. For this, if the tumor in the leg is large, a few cycles of chemotherapy should be applied first. After the original tumor has shrunk, it must be surgically removed. The chemotherapy given is expected to be effective not only on the tumor in the leg but also on metastases in the lung. To understand how effective the treatment is, lung metastases should be re-evaluated with tomography or PET-CT. If non-disappearing metastases are detected, these should also be surgically removed. In addition to all these treatments, radiation therapy to the original tumor bed in the leg may also be considered.
Your sibling’s illness is a condition that must be decided together by the medical oncologist, radiation oncologist, and surgeons. Even this case demonstrates the importance of tumor boards with doctors from different branches in oncology.
Prof. Dr. Coşkun Tecimer
