{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:55:31Z","timestamp":1787237731006,"version":"build-2736575974"},"reference-count":51,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Radiology, Feinberg School of Medicine, Northwestern University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: To correlate size changes in undifferentiated pleomorphic sarcoma (UPS) on magnetic resonance imaging (MRI) after neoadjuvant chemoradiation therapy (nCRT) with pathological response, risk of local recurrence, and therapeutic regimens. Methods: This retrospective study analyzed clinical, pathological, and imaging data from 39 biopsy-proven UPS subjects. Four readers measured the tumor dimensions before and after nCRT, including two perpendicular axial diameters and the longest coronal\/sagittal diameter. Three cross-sectional areas and bounding volume were also calculated. Responders (pR) were defined as having \u226410% viable cells and non-responders (pNR) as having more. Inter-reader agreement was evaluated using Kendall\u2019s concordance coefficient. Changes in tumor size were compared between pR and pNR using one-way ANOVA and Tukey\u2019s HSD test for multiple comparisons of means. Results: pR showed a greater increase in size across all measurements compared to pNR. For the longest axial diameter, the mean increase was 30% \u00b1 35% for pR and 14% \u00b1 31% for pNR, with a mean difference (pR-pNR) of 16% (95% CI: 6\u201327%, p = 0.003). In tumors treated with radiotherapy alone, pR exhibited larger size increases in all dimensions compared to pNR. In contrast, in the chemoradiation group, pR showed a slight increase, while pNR generally shrank, although these differences did not reach statistical significance. Notably, pNR with local recurrence exhibited a reduction in all tumor dimensions compared to pNR without local recurrence. Conclusions: This exploratory study suggests that tumor size changes may predict pathological response and local recurrence after nCRT in UPS; however, the small sample size limits the generalizability of these findings.<\/jats:p>","DOI":"10.3390\/cancers17050830","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T08:05:54Z","timestamp":1740729954000},"page":"830","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Paradoxical Response to Neoadjuvant Therapy in Undifferentiated Pleomorphic Sarcoma: Increased Tumor Size on MRI Associated with Favorable Pathology"],"prefix":"10.3390","volume":"17","author":[{"given":"Mariam H.","family":"Goreish","sequence":"first","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00f2","family":"Gennaro","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6752-3354","authenticated-orcid":false,"given":"Laetitia","family":"Perronne","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1608-1955","authenticated-orcid":false,"given":"Gorkem","family":"Durak","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir A.","family":"Borhani","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2156-9664","authenticated-orcid":false,"given":"Hatice","family":"Savas","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Kelahan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Avery","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Subedi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tugce","family":"Agirlar Trabzonlu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7379-6829","authenticated-orcid":false,"given":"Ulas","family":"Bagci","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baris","family":"Turkbey","sequence":"additional","affiliation":[{"name":"Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spyridon","family":"Bakas","sequence":"additional","affiliation":[{"name":"Department of Pathology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Sachdev","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"},{"name":"Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5689-1100","authenticated-orcid":false,"given":"Ronen","family":"Sumagin","sequence":"additional","affiliation":[{"name":"Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borislav A.","family":"Alexiev","sequence":"additional","affiliation":[{"name":"Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"},{"name":"Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Hermida de Viveiros","sequence":"additional","affiliation":[{"name":"Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"},{"name":"Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2466-0607","authenticated-orcid":false,"given":"Seth M.","family":"Pollack","sequence":"additional","affiliation":[{"name":"Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"},{"name":"Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2287-5727","authenticated-orcid":false,"given":"Yuri S.","family":"Velichko","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"},{"name":"Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1056\/NEJMra041866","article-title":"Soft-tissue sarcomas in adults","volume":"353","author":"Clark","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1038\/nrc1168","article-title":"Mechanisms of sarcoma development","volume":"3","author":"Helman","year":"2003","journal-title":"Nat. Rev. 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