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What are the benefits of chemotherapy treatment post knee amputation and soft tissue sarcoma?

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Posted on Fri, 14 Feb 2014
Question: Hello my partner a 53 year old female has recently undergone a below knee amputation November 2013 for high grade soft tissue sarcoma which originated in her first metatarsal which was originally diagnosed as a stress fracture - april 2013. Pre-op radiation was ineffective and the tumour grew to about 4.5cms in her foot. While the surgery was successful she is now undergoing chemotherapy has had two rounds - so 10 treatments with three more rounds to go. The oncologist has not said either way whether the chemo is of benefit. We have not found any evidence to suggest that she will benefit from it. The Pet scan was clear pre surgery, would welcome your opinion and advice. Many thanks XXXXXXX
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Answered by Dr. K. Harish (4 hours later)
Brief Answer: You need to undergo chemotherapy Detailed Answer: I suppose amputation is correct for a sarcoma. Probably there were no means to preserve the limb based on the location of the tumor. The PET scan has not shown any spread elsewhere. That is a good sign. Chemotherapy is being administered since the tumor is high grade. The utility of chemotherapy is debatable. Generally for a fit or younger patient the policy is to err on the side of administration of chemotherapy. Although the PET scan does not show any spread, there are always chances of microscopic spread of the disease which cannot be detected by any currently available investigation. Hence, in a high grade sarcoma, the chances of such undetected spread being high, the doctor would usually err on the side of chemotherapy. The usefulness of chemotherapy would be in the range of 15-25%. Unfortunately there is no way to ascertain whether you would be in that category of usefulness or not. In addition, since there is no detectable disease, the efficacy of the drug in you cannot be evaluated. With no detectable disease, it would be better to over-treat than under-treat as the doctor would like to give you that additional benefit in the attempt to cure. Hence, even with usefulness in doubt, it would be advisable to undergo chemotherapy.
Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. K. Harish (14 hours later)
Dear Dr Karish Thank you for your response which is very consistent to that of Mary-Ellen's oncologist and surgeon. I guess we were hoping to find out whether having two rounds was going to be enough as the rounds are quite brutal insofar as feeling incredibly unwell and the amount of toxins being infused is very high. I have been unable to find any information that supports the efficacy of ceasing treatment part way through and any information that supports the continuation of same for as you say she is in a high risk category and it's perhaps better to err on the side of caution. Can you recommend anyone that might consider a combination of traditional and complementary treatment? We live in Western Australia but can travel. With kind regards XXXXXXX
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Answered by Dr. K. Harish (31 minutes later)
Brief Answer: Complete the cycles if possible Detailed Answer: Treatment protocols are based on trials done on the same disease. Many of these have been done across continents. The dosage and schedules are based on earlier lab, animal and human data. Hence if 'X' cycles of chemotherapy are advised, you would not find any data to support a couple of cycles less or a couple of cycles more of the same therapy. At present, the practice is to administer chemotherapy based on the disease type, organ, stage etc. We have not yet reached a stage where therapy can be tailor made for individuals. The advice would be to take all the cycles. This perhaps answers your first part of the question. Traditional and complimentary treatments are like going into unchartered seas. Modern medicine is evidence based and objective. While this has many pluses, the same objectivity is a handicap also. The main concern while using alternative therapy is that they are not standardized. Hence, you could benefit from some while others could be harmful. Again, since it is subjective, there is no way to assess their usefulness in a large setting. I am not an expert in that field. I have just put across broad ideas. I am neither supporting nor discouraging you from that. You have to decide on that on your own. I understand that chemotherapy is toxic. What we generally advice in our place is "please undergo our treatment completely; follow alternative therapies later if you are confident about it".
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. K. Harish

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What are the benefits of chemotherapy treatment post knee amputation and soft tissue sarcoma?

Brief Answer: You need to undergo chemotherapy Detailed Answer: I suppose amputation is correct for a sarcoma. Probably there were no means to preserve the limb based on the location of the tumor. The PET scan has not shown any spread elsewhere. That is a good sign. Chemotherapy is being administered since the tumor is high grade. The utility of chemotherapy is debatable. Generally for a fit or younger patient the policy is to err on the side of administration of chemotherapy. Although the PET scan does not show any spread, there are always chances of microscopic spread of the disease which cannot be detected by any currently available investigation. Hence, in a high grade sarcoma, the chances of such undetected spread being high, the doctor would usually err on the side of chemotherapy. The usefulness of chemotherapy would be in the range of 15-25%. Unfortunately there is no way to ascertain whether you would be in that category of usefulness or not. In addition, since there is no detectable disease, the efficacy of the drug in you cannot be evaluated. With no detectable disease, it would be better to over-treat than under-treat as the doctor would like to give you that additional benefit in the attempt to cure. Hence, even with usefulness in doubt, it would be advisable to undergo chemotherapy.