How do you approach a patient with undifferentiated pleomorphic sarcoma encasing the spinal cord post radiation for neurological deficits for further management?

We will need some more information here. Did the patient present with cord compression? What level of cord is involved? Is the tumor causing functional issues in the patient (paralysis, bladder issues, etc.)? What was the dose of radiation used? Was this definitive RT or palliative RT? Is there any metastasis? What is the age and performance status of this patient?

Considering the wrap around the spinal cord, I am thinking that this is not a resectable tumor. Hence, I would suggest starting systemic treatment. Usually, our go-to regimen is DOXORUBICIN (75 mg/m2) combined with IFOSFAMIDE (6-8 gm/m2) divided over 3 to 5 days. However, this recommendation is dependent on the performance status of the patient.

In any scenario, an anthracycline...