title: Evaluating the Role of Interdigitated Neoadjuvant Chemotherapy and Radiation in the Management of High-Grade Soft-Tissue Sarcoma: The Johns Hopkins Experience.
abstract: OBJECTIVE
  High-grade soft-tissue sarcoma (STS) has a poor prognosis. The goal of this study was to review treatment outcomes of patients with high-grade STS treated with interdigitated neoadjuvant chemotherapy (CT) and radiation at our institution.
  
  
  METHODS
  Patients with high-grade STS (1997 to 2010) were planned for treatment with 3 cycles of neoadjuvant CT, interdigitated preoperative radiation therapy (44 Gy administered in split courses with a potential 16 Gy postoperative boost), and 3 cycles of postoperative CT. Cancer control outcomes at 3 years were analyzed.
  
  
  RESULTS
  Sixteen patients with high-grade STS were evaluated. Median age was 53 years, the median longest tumor diameter was 14.6 cm, and median follow-up was 33 months. All 16 patients received 2 or 3 cycles of neoadjuvant CT and all patients completed neoadjuvant RT. The estimated 3-year rate for local control was 100%, disease-free survival 62.5%, and overall survival 73.4%.
  
  
  CONCLUSIONS
  Patients with high-grade STS treated with interdigitated neoadjuvant CT and radiation before surgical resection had excellent rates of local control, along with disease-free survival and overall survival similar to previously published reports. This combined-modality approach continues to have a role in the treatment of patients with high-grade STS.
authors.affiliation: *Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine Departments of †Medical Oncology ‡Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD §Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Raju R
authors.initials: RR
authors.lastname: Raval
authors.forename: Deborah
authors.initials: D
authors.lastname: Frassica
authors.forename: Katherine
authors.initials: K
authors.lastname: Thornton
authors.forename: Christian
authors.initials: C
authors.lastname: Meyer
authors.forename: David S
authors.initials: DS
authors.lastname: Ettinger
authors.forename: Frank
authors.initials: F
authors.lastname: Frassica
authors.forename: Kristin
authors.initials: K
authors.lastname: Weber
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Terezakis
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome; D055815:Young Adult