Patients with sarcoma may need one or more types of treatment, including surgery, chemotherapy, or radiotherapy. The management of sarcoma can be very complex and requires the involvement of a multidisciplinary team.

The five year survival rates for adults and children with bone and soft tissue sarcomas are estimated at 70 per cent and 67 per cent respectively.

This depends on the extent of disease at diagnosis (stage), the tumour characteristics (some sarcomas are more aggressive than others in spreading) and response to treatment.

Multidisciplinary Teams

The RPA Sarcoma Service brings together healthcare professionals from different specialties to discuss a patient’s cancer diagnosis and to discuss treatment options. 

Our multidisciplinary team consists of surgeons, medical oncologists, radiation oncologists, pain medicine specialists, pathologists, radiologists and imaging specialists, anaesthetists, clinical trial researchers, nurses, social workers, psychologists, palliative care, physiotherapists, speech pathologists, occupational therapists and dietitians. 

Each patient’s case is reviewed at the weekly Bone and Soft Tissue Tumour multidisciplinary team meeting at RPA. 

Following a biopsy, a diagnosis is then made with radiology and histopathology correlation. Patient management plans are then made. 

Patients do not attend the multidisciplinary team meeting, but they are notified of the outcomes of their case discussion during the next consultation with their treating health professional. 

Surgery

A comprehensive range of surgery is provided by the RPA Bone and Soft Tissue Sarcoma Unit.

The timing of surgery needs to be carefully coordinated, and as the procedure is highly specialised, each patient’s case needs individualised planning.

Our Tumour Orthopaedic Surgeons operate at the following hospitals – Royal Prince Alfred Hospital; Institute of Rheumatology and Orthopaedics (for patients 16 years and over); Children’s Hospital at Westmead; Sydney Children's Hospital at Randwick; North Shore Private Hospital (private patients only); and Chris O’Brien Lifehouse (private patients only).

Anaesthetics

Anaesthetists are responsible for many aspects of the patient’s well-being as they prepare for, undergo and recover from surgery for their sarcoma.

During surgery, anaesthetists perform a combination of advanced general and regional anaesthetic techniques, transfuse blood, give appropriate pain relief and monitor the patient closely to guide them safely through complex and variable surgery.

In the postoperative period, pain specialists from the anaesthetic department support patients. The pain specialists communicate with nursing staff, physiotherapists and surgeons to help patients achieve their best possible results from surgery.

Nursing and Allied Health

The Sarcoma Clinical Nurse Consultant may receive a referral at any point in the patients’ journey and make contact to assist. The role of the Clinical Nurse Consultant includes, but is not limited to, explaining the services of the RPA Bone and Soft Tissue Sarcoma Unit, acting as a point of contact for the patient and clinicians at all stages, supporting the patient in their home environment remotely, linking patients in with appropriate services and non-government organisations, advocating for the patient and providing a supportive environment. 

Referrals to appropriate Allied Health clinicians are made to provide therapy to optimise the physical, emotional and functional ability of patients.

These services might include Psycho-oncology, AYA Psycho-oncology, Social Work, Occupational Therapy, Physiotherapy, Exercise Physiology, Dietetics and Speech Pathology.

Radiation Oncology

Radiation oncology or therapy uses high-energy rays or particles to kill cancer cells. Radiation can be given before surgery (neoadjuvant treatment) to shrink the tumour and make it easier to remove. It can also be given after surgery (adjuvant treatment) to kill any cancer cells that may be left behind after surgery.

Radiation therapy can also be used to help ease symptoms of sarcoma when it has spread as part of palliative care.

Patients sixteen years and above should be referred to the Radiation Oncologist at the Chris O’Brien Lifehouse. Patients aged fifteen and fourteen years can be assessed per case for suitability of treatment at all facilities. Children aged thirteen years and less must be referred to a Paediatric Radiation Oncologist who specialises in sarcoma at one of the children’s hospitals. One exception is for palliative care patients aged twelve years and above for treatment at the Chris O’Brien Lifehouse, if required and appropriate, for ease of the patient’s family.

Radiation Therapy occurs at Chris O’Brien Lifehouse; Children’s Hospital at Westmead; and Sydney Children’s Hospital.

Medical Oncology – Chemotherapy

Chemotherapy can be either a systemic adjuvant treatment with the primary goal of treating microscopic disease at the time of initial presentation, or as a complement to local treatment by surgery or radiation.

As a local treatment, the goal of chemotherapy is to ‘downstage’ the tumour enabling surgery or radiation to achieve local disease control.

Patients sixteen years and above are referred to the Adolescent Medical Oncologist at the Chris O’Brien Lifehouse. Adolescents aged fifteen years will be assessed if most appropriate to be treated in an adult hospital or a children’s hospital. Children aged fourteen years and less will be referred to a Paediatric Medical Oncologist who specialises in sarcoma at one of the children’s hospitals.

Chemotherapy is administered at Chris O’Brien Lifehouse; Children’s Hospital at Westmead; and Sydney Children’s Hospital.

Pathology

The Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, provides the diagnostic histopathology service for the Bone and Soft Tissue Sarcoma Unit, and as such provides diagnoses for patients from Royal Prince Alfred Hospital, Chris O’Brien Lifehouse, as well as a state-wide and national consultation service. 

Palliative Care and Support

Patients can be referred to the Supportive and Palliative Care team for a range of therapies, including:

• Pain management throughout treatment and thereafter
• Symptom management throughout treatment and thereafter
• Quality of life practices
• End of Life care

RPA Virtual Hospital

RPA Virtual Hospital offers a 24 hour sarcoma support service for patients of the RPA Sarcoma Service and Chris O'Brien Lifehouse Sarcoma Service. The multidisciplinary Virtual Care Centre is available to patients, their families and carers for advice on symptom management, pain, chemotherapy, radiotherapy or any concerns or questions before or after surgery. 

Supporting Sarcoma Patients

There are a range of organisations to help support patients, their families and friends.

Cancer Council NSW	Resources and support services to help guide you through cancer.
Cancer Institute NSW	Working with the health system and the community to help improve cancer outcomes for everybody.
Canteen	Provides tailored support for young people impacted by cancer.
Cooper Rice-Brading Foundation	Funding initiatives to support clinical research, raising awareness of sarcoma and providing support for sarcoma patients and their families.
Rare Cancers Australia	Patient support programs, fundraising and research to improve the lives and health outcomes of Australians living with rare, less common and complex cancers.
Redkite	Practical, financial and mental health support services for families facing childhood cancer.
Sony Foundation	Inspiring partners and the public to raise significant funds for youth causes through entertainment, technology and creativity.
Starlight Children's Foundation	Partnering with health professionals to bring the fun, joy and laughter that is essential to sick kids’ health and wellbeing.