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Sarcomas

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Description

Sarcomas and other connective tissue tumors of soft tissue and bone are rare lesions.

Highly complex and heterogeneous, there are approximately 5,000 new cases per year. These tumors can develop anywhere from head to toe, at any age.

They appear as swellings that vary greatly in size (1 cm to several tens of centimeters). They can grow slowly over several years or quickly over a few weeks.

There are three main categories of sarcomas:

  • soft tissue sarcomas (58% of sarcomas, approximately 2,400 new cases/year in France),
  • visceral sarcomas (30%, approximately 1200 new cases/year), such as GIST (gastrointestinal stromal tumors) or uterine sarcomas,
  • bone sarcomas (12%, approximately 500 new cases/year).

The CGFL is part of the NetSarc+ network: a national reference network for rare cancers related to sarcoma (certified by the INCA in 2019). Comprised of 25 centers hosting a Sarcoma RCP, it carries out various missions related to this pathology: treatment recommendations, referral activities, research coordination, etc.

To learn more, click here.

The CGFL is both a competent center for clinical care and for anatomopathological and molecular diagnosis.

DIAGNOSTICS

Sarcomas are difficult to diagnose because, being rare, their presentation is poorly understood. They can sometimes mimic a benign tumor, a hematoma, in the form of a swelling.
Several learned societies have proposed guidelines, particularly for all tumors larger than 5 cm and without an obvious cause. These tumors must be evaluated by a specialist if a sarcoma is suspected, with a view to a diagnostic microbiopsy before any therapeutic treatment is initiated.

Diagnosis is based on microbiopsies under radiological guidance after appropriate imaging.
– The standard imaging is MRI.
– A radiologist and a surgeon from the CGFL discuss the possibility of performing a biopsy. This biopsy is the key step in diagnosis. It must be performed, according to standard practice recommendations, by a radiologist or a surgeon trained in the management of these tumors.
– A microscopic examination of the sample will be performed by the team from the CGFL’s Department of Pathology, a center of expertise for sarcomas and GISTs. This examination is supplemented by molecular biology or molecular characterization techniques.
A staging assessment allows us to assess the local, regional, and metastatic spread of the disease. It is performed using a CT scan.

MULTIDISCIPLINARY CONSULTATION

The CGFL offers patients with a strong suspicion of sarcoma a multidisciplinary consultation (the SARCOMA committee). They can thus meet simultaneously with a medical oncologist, a surgeon and a radiologist with a possible microbiopsy on the same day.

Treatments

Treatment of CGFL sarcomas, like other types of cancer, involves surgery, radiotherapy and medical treatments.

SURGERY

Surgery is the key step in treatment. It is performed after discussion in a sarcoma multidisciplinary meeting. It is recommended that surgery be performed by a surgeon specializing in sarcomas, soft tissue, bone, or GIST, as the surgical treatment rules are highly codified and sometimes determine the risk of relapse.

DRUG TREATMENTS: CHEMOTHERAPY, TARGETED THERAPY, IMMUNOTHERAPY

Chemotherapy and/or targeted therapies sometimes precede surgery. The goal of these treatments is to achieve local and general control of the disease. These treatments are prescribed based on the diagnostic tests performed.
These treatments can also be administered after surgery: this is referred to as adjuvant chemotherapy. In all cases, these treatments are discussed and decided upon during a sarcoma multidisciplinary team meeting.
Numerous therapeutic innovations, such as targeted therapies and immunotherapies, can also be offered to patients. Through therapeutic trials, they will be able to access promising new molecules.

RADIOTHERAPY

Radiotherapy sometimes precedes surgery to facilitate it. It may also be prescribed after surgery to reduce the risk of relapse. Again, these treatments are discussed and decided upon at a sarcoma multidisciplinary meeting.

DEDICATED RCP

A Multidisciplinary Consultation Meeting (RCP) which takes place at the CGFL allows for the study of all files by several health professionals (radiologists, pathologists, surgeons, medical oncologists and radiotherapists). This is both a diagnostic and therapeutic RCP.

Diagnostic RCP: the files are discussed from the initial management when the soft tissue or bone mass is discovered. The objective of the RCP is to determine the additional imaging tests that may be necessary and to indicate the indication for a biopsy in the presence of the surgeon in order to be able to make a diagnosis before any therapeutic management.
RCP thérapeutique : un parcours thérapeutique spécifique à chaque patient est établi en fonction du type histologique, du bilan d’imagerie et de l’état général du patient. Il peut faire intervenir différentes spécialités : la chirurgie, l’oncologie ou encore la radiothérapie.

Please note that this RCP certified by the Inca is shared (by video) with the CHRU of Besançon, thus covering the entire Bourgogne Franche Comté region.

CLINICAL TRIALS

Thanks to the CGFL’s research expertise, patients with sarcomas can access clinical trials and innovative therapies.

Clinical research trials available at the CGFL can be viewed by clicking here.

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