Establish intent of treatment:

• curative
• anti-cancer therapy to improve quality of life and/or longevity without expectation of cure
• symptom palliation.

Surgery: Surgery (resection and reconstruction) is the most common treatment option. Most patients are considered as candidates for limb salvage surgery. Appropriate vascular and plastic surgical reconstructive options should be available.

Radiation therapy: All patients with large, localised, soft tissue tumours should be considered for radiation therapy before or after surgery. Radiation should also be considered for smaller tumours (under 5 cm) and lower grade tumours in more difficult anatomic sites. Other than Ewing’s sarcoma, radiation therapy for bone sarcomas is mainly used for palliation.

Chemotherapy or drug therapy:

• All patients with osteosarcoma and Ewing’s sarcoma should be considered for protocolised pre- and/or postoperative chemotherapy.
• Other forms of bone sarcomas should be treated as per multidisciplinary team discussion.
• Rhabdomyosarcoma should be treated with protocolised pre- and/or postoperative chemotherapy.

Fertility preservation options should be discussed where appropriate.

Palliative care: Early referral can improve quality of life. Referral should be based on need, not prognosis.

Communication – lead clinician to:

• discuss treatment options with the patient/carer (including the intent, risks and benefits)
• discuss advance care planning with the patient/carer where appropriate
• discuss the treatment plan with the patient’s general practitioner.

For more information see detailed guidelines about Sarcoma.