
LMS is a chemotherapy and radiation resistant cancer. Surgical or ablative methods are the treatments of choice. Therefore be very thoughtful if offered chemotherapy or radiation for treatment. See below.

     <b>CLEAR MARGINS are wide, cancer-free margins surrounding the tumor on the surgically removed tissue. For internal tumors, margins are hopefully 10mm or more, for external tumors margins are measured in cm or inches.  </b>

a. Definition: Adjuvant treatment is treatment given when all evidence of the cancer has been resected [removed surgically.]

b. Definition: If the surgery resulted in a total removal of the cancer, with wide, cancer-free margins on the surgical specimen, this is called surgical excision [or resection] with wide, clear margins. You need wide margins because the LMS sends tendrils out into the normal tissue, beyond the apparent border of the tumor.  LMS tumors sometimes have "pseudocapsules".  They look like they are encapsulated, but aren't.  It isn't a capsule containing the tumor, it is tumor cells crammed up against other tissue looking like a capsule.  The tumor sends tendrils beyond the apparent border of the tumor, into healthy tissue.  That is why wide margins are necessary.

c. For primary tumors on many sites, adjuvant treatment has not proven to be of benefit if the surgical excision had wide, clear margins. The adjuvant treatments recommended are usually either radiation or chemotherapy, sometimes both. Either of these carries risks of creating permanent and troublesome damage to your body. Think twice about trading off the possibility of permanent damage AND loss of a treatment option, for NO proven benefit against the LMS.  However, for other sites there may actually be benefit from adjuvant treatment.  <b>To be current with the latest findings, discuss decisions with a sarcoma oncologist, and look up treatment statistics about your primary site on &&url. </b>

d. If you have No Evidence of Disease present [called NED, also called "in remission"] and oncologist recommends chemotherapy or radiation for you, ask for the medical article describing the research study that proves chemotherapy or radiation improves survival in your particular situation. <b> However, if the surgical margins are positive, and not clear, often radiotherapy and/or chemotherapy can increase survival times.</b>

e. <b>Make sure that the research study is about LMS and NOT sarcomas in general.</b> [Sarcomas vary in their response but LMS is a chemo and radiation resistant cancer. Surgery is the treatment of choice for LMS, followed by other ablative methods.]

        <b>POSITIVE MARGINS  [Tumor cells are present at the edge or close to the edge of the removed tumor tissue.]</b>  If the surgeons feel that the margins are not wide enough, WHAT is stopping them from going in and taking more tissue out to get clear margins?

Certainly, sometimes this is done.  It is much easier to re-operate to obtain clear margins on the more superficial lesions and on extremity lesions.  But internally, sometimes the margins are only microscopically positive, and it cannot be determined EXACTLY where the tumor cells are--and perhaps the initial cut through them would have smeared the LMS cells over a wider surface.  SOMETIMES the margins are positive because internal vital structures or organs were involved and the tumor had to be scraped off the structure or organ.  Sometimes the tumor burst as it was being removed.

<b> If tumor is left behind, often radiation [and sometimes chemotherapy] is offered as treatment, and does often confer a benefit in longer survival times.  You need to see and/or discuss the research pertaining to your particular situation.  Radiation in LMS is often used locally, to prevent local recurrence, or palliatively to treat inoperable tumors. Radiotherapy cannot prevent metastases. </b>