A 2007 study published in the Annals of Surgery showed that patients with soft tissue sarcoma treated at large volume centers, such as Duke, have higher survival rates and better functional outcomes than those at smaller volume centers.

Brian Brigman, MD, PhD, and Shalini Ramasunder, MD, orthopaedic surgeons; Rich Riedel, MD, a medical oncologist; David Kirsch, MD, PhD, and Nicole Larrier, MD, radiation oncologists; Susan Blackwell, PA; Sherry Dufore, RN; and Deborah Jackson form Duke’s multidisciplinary sarcoma clinic.

In addition to treating sarcomas, Riedel, Brigman, and Kirsch are conducting basic and clinical research to learn more about these rare cancers. We asked Brigman and Riedel to discuss sarcomas and what the future looks like for these diseases.

Can you explain what sarcomas are and how they are treated?

Brian Brigman, MD, PhD Dr. Brigman: Sarcomas describe a group of at least 50 types of cancers that impact bones and soft tissue (such as muscles and nerves). These cancers are rare. About 12,000 people a year are diagnosed with a type of sarcoma in the United States. For comparison’s sake, more than 200,000 people in the U.S. are diagnosed with lung cancer each year. According to the National Cancer Institute, the five-year survival rate of sarcoma patients is 66 percent.

Richard Riedel, MD Dr. Riedel: Despite the large number of sarcoma subtypes, treatment for the majority of patients is very similar. Generally speaking, surgical resection with consideration for radiation therapy either before or after surgery is the “standard of care” for most soft tissue sarcomas. While chemotherapy plays an important role in patients with advanced disease, its role in patients with localized disease is controversial and its use is recommended on a case-by-case basis.

What are some challenges you encounter when treating and researching sarcoma?

Dr. Brigman: Sarcomas can occur in any part of the body, in patients of any age. Determining the best treatment plan requires a multidisciplinary approach from surgeons, medical oncologists, radiation oncologists, pathologists, and radiologists to individualize treatment for each patient. Since there are fewer patients with sarcomas, accruing enough patients to enroll for clinical trials to test new treatments can be challenging. In addition, there is less funding available to support research for rare cancers like sarcomas.

Dr. Riedel: Performing clinical trials on rare cancers can be challenging. To address this concern, we have partnered with SARC (Sarcoma Alliance for Research through Collaboration), a cooperative group of sarcoma centers from across the country dedicated to the development and support of clinical trial research.

Tell us more about the research being conducted on sarcoma at Duke.

Dr. Brigman: Dr. David Kirsch, a radiation oncologist, has created a mouse model for soft tissue sarcoma. This is an exciting first step to determine what treatments for sarcoma may be effective in humans. Dr. Corinne Linardic, a pediatric oncologist, is studying rhabdomyosarcoma, the most common soft tissue sarcoma of children and young adults, to learn more about the genetic mutations associated with this disease.

Dr. Riedel: Building on recent efforts through Duke’s Institute for Genome Sciences & Policy, we hope to develop prediction tools for disease recurrence and treatment response by linking unique information provided by tumor samples with clinical data available from patients. While we have much to learn, it is clear that Duke is a leader both on the clinical and research fronts for patients with this rare and fascinating group of diseases.