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Living with cancer·Standard of care

Alveolar soft part sarcoma: the decisions you may face

Cancer page →Second-opinion finder →

3 treatment settings, 3 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.

3 options

Wide resection with radiotherapy for close or positive margins; surveillance of lungs and brain.

The options, in plain words
Limb-salvage surgery and endoprosthetic reconstructionStandard of care

Removing a bone or soft-tissue sarcoma while keeping the arm or leg, rebuilding with metal implants, bone grafts or growing prostheses in children.

  • Preserves function without compromising survival
  • Custom implants for pelvis and spine
IMRT / IGRT (modern external beam)Standard of care

IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.

  • Conformal dose, fewer side effects
  • Hypofractionation saves visits
MRIStandard of care

MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.

  • No ionising radiation
  • Best soft-tissue and brain imaging
  • Functional sequences (diffusion, perfusion)
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Limb-salvage surgery and endoprosthetic reconstruction
  • Implant infection and mechanical failure over decades
  • Requires specialist sarcoma centres
IMRT / IGRT (modern external beam)
  • Low-dose bath to normal tissue
  • Motion management
MRI
  • Slow and expensive
  • Motion artefacts
  • Gadolinium concerns in renal impairment
Questions to ask about this decision
  1. Between Limb-salvage surgery and endoprosthetic reconstruction, IMRT / IGRT (modern external beam) and MRI, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. For my situation (localised), which of the standard options do you recommend and why?
    Why: Guideline options include: Wide resection with radiotherapy for close or positive margins; surveillance of lungs and brain.

Add these to your appointment list, or take the full question set for this cancer.

Advanced, first line

Advanced, first line

5 optionsCompare side by side →

Atezolizumab (FDA approved 2023) or a VEGFR kinase inhibitor (sunitinib, pazopanib; anlotinib in China); conventional chemotherapy is not used.

The options, in plain words
AtezolizumabApprovedMonoclonal antibody (anti-PD-L1)

A PD-L1 blocker used in lung, liver, and bladder cancer. In 2026 it became the first drug approved based on a blood test showing leftover cancer after bladder surgery.

Immune checkpoint inhibitorsStandard of care

Immune checkpoint inhibitors are antibodies against CTLA-4, PD-1 or PD-L1 that release the brakes on T cells so they attack the cancer. They are approved in more than 20 tumour types and produce lasting, sometimes curative responses that chemotherapy rarely does, but most patients do not respond and autoimmune side effects are the cost.

  • Durable, sometimes curative responses
  • Broad applicability
SunitinibApprovedSmall-molecule multi-kinase inhibitor (VEGFR, PDGFR, KIT)

Sunitinib is an anti-angiogenic pill approved for pancreatic neuroendocrine tumours, kidney cancer and GIST.

PazopanibApprovedSmall-molecule kinase inhibitor (VEGFR/PDGFR/KIT)

Pazopanib is the only multi-kinase inhibitor approved for soft-tissue sarcoma (excluding fat-derived tumours), used after chemotherapy fails.

AnlotinibApprovedSmall-molecule multi-kinase inhibitor (VEGFR, FGFR, PDGFR, KIT)

Anlotinib is one of the most used cancer pills in China, first approved for lung cancer after other treatments have failed and then for several rarer tumours.

The evidence behind it
The main trade-offs on record
Atezolizumaball recorded rates →
Side effectAny gradeGrade 3+
Pneumonitis (immune-mediated) · Monotherapy pooled3%0.8%
Hepatitis (immune-mediated) · Monotherapy pooled1.8%0.7%
Colitis (immune-mediated) · Monotherapy pooled1%0.5%
Hypothyroidism (immune-mediated) · Monotherapy pooled4.9%0.2%

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Immune checkpoint inhibitors
  • Most patients do not respond
  • Autoimmune toxicity
  • Biomarkers are imperfect
Sunitiniball recorded rates →
  • Avoid grapefruit.
  • Known QT prolongation. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
Pazopaniball recorded rates →
  • Take on an empty stomach (1 hour before or 2 hours after food).
  • Known QT prolongation. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
  • 200 mg daily in moderate impairment; avoid in severe.
Questions to ask about this decision
  1. Between Atezolizumab, Immune checkpoint inhibitors, Sunitinib and the other options, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. How closely do I match the people in Phase III Trial of Anlotinib, Catequentinib in Advanced Alveolar Soft Part Sarcoma, Leiomyosarcoma, Synovial Sarcoma (APROMISS), and does that change what the results mean for me?
    Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
  4. Which side effects of Atezolizumab are most likely for me, which are reversible, and which would make us stop?
    Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
  5. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  6. For my situation (advanced, first line), which of the standard options do you recommend and why?
    Why: Guideline options include: Atezolizumab (FDA approved 2023) or a VEGFR kinase inhibitor (sunitinib, pazopanib; anlotinib in China); conventional chemotherapy is not used.
  7. Am I a candidate for Atezolizumab, Sunitinib, Pazopanib or related drugs, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  8. How do the results of Phase III Trial of Anlotinib, Catequentinib in Advanced Alveolar Soft Part Sarcoma, Leiomyosarcoma, Synovial Sarcoma (APROMISS) apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

Special situations

Oligometastatic

2 options

Metastasectomy or stereotactic radiotherapy to lung and brain lesions in slowly progressing disease.

The options, in plain words
SBRT / SABR (stereotactic radiotherapy)Standard of care

Stereotactic body radiotherapy converges multiple beams with sub-millimetre accuracy to deliver tumour-destroying doses in one to five outpatient sessions, doing the job of surgery for inoperable early lung cancer and for metastases in liver, spine and brain. Tumour size and location limit its use, and late toxicity is a concern near the central airways.

  • Ablative doses with minimal recovery
  • Outpatient
Limb-salvage surgery and endoprosthetic reconstructionStandard of care

Removing a bone or soft-tissue sarcoma while keeping the arm or leg, rebuilding with metal implants, bone grafts or growing prostheses in children.

  • Preserves function without compromising survival
  • Custom implants for pelvis and spine
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
SBRT / SABR (stereotactic radiotherapy)
  • Size and location limits
  • Late toxicity near central airways
Limb-salvage surgery and endoprosthetic reconstruction
  • Implant infection and mechanical failure over decades
  • Requires specialist sarcoma centres
Questions to ask about this decision
  1. Between SBRT / SABR (stereotactic radiotherapy) and Limb-salvage surgery and endoprosthetic reconstruction, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. For my situation (oligometastatic), which of the standard options do you recommend and why?
    Why: Guideline options include: Metastasectomy or stereotactic radiotherapy to lung and brain lesions in slowly progressing disease.

Add these to your appointment list, or take the full question set for this cancer.

How to read this page. Options and results come from OnCo records with their sources; the settings are the standard-of-care rows on the cancer page, and the lines of therapy are on the sequencing grid. Where a setting names one path, the choice is usually about timing, trials and where to be treated: see expert centres. OnCo is orientation, not medical advice.