PURPOSE: On the basis of a positive reported single-institution pilot study, the 
Radiation Therapy Oncology Group initiated phase II trial 9514 to evaluate its 
neoadjuvant regimen in a multi-institutional Intergroup setting.
PATIENTS AND METHODS: Eligibility included a high-grade soft tissue sarcoma > or 
= 8 cm in diameter of the extremities and body wall. Patients received three 
cycles of neoadjuvant chemotherapy (CT; modified mesna, doxorubicin, ifosfamide, 
and dacarbazine [MAID]), interdigitated preoperative radiation therapy (RT; 44 
Gy administered in split courses), and three cycles of postoperative CT 
(modified MAID).
RESULTS: Sixty-six patients were enrolled, of whom 64 were analyzed. 
Seventy-nine percent of patients completed their preoperative CT and 59% 
completed all planned CT. Three patients (5%) experienced fatal grade 5 
toxicities (myelodysplasias, two patients; infection, one patient). Another 53 
patients (83%) experienced grade 4 toxicities; 78% experienced grade 4 
hematologic toxicity and 19% experienced grade 4 nonhematologic toxicity. 
Sixty-one patients underwent surgery. Fifty-eight of these were R0 resections, 
of which five were amputations. There were three R1 resections. The estimated 
3-year rate for local-regional failure is 17.6% if amputation is considered a 
failure and 10.1% if not. Estimated 3-year rates for disease-free, 
distant-disease-free, and overall survival are 56.6%, 64.5%, and 75.1%, 
respectively.
CONCLUSION: This combined-modality treatment can be delivered successfully in a 
multi-institutional setting. Efficacy results are consistent with previous 
single-institution results.