Enrico Martin

94 Chapter 5 Overall p=0.023 0% 25% 50% 75% 100% Surgical Oncology Neurosurgery Plastic Surgery Other Specialties Generally not Radiology Biopsy Radiology and biopsy Preoperative diagnostics A 0% 25% 50% 75% 100% MRI CT−thorax FDG−PET Other SurgicalOncology Neurosurgery PlasticSurgery OtherSpecialties Preoperative imaging B Overall p<0.001 0% 25% 50% 75% 100% Surgical Oncology Neurosurgery Plastic Surgery Other Specialties CT−thorax FDG−PET Both No staging Preoperative staging C Overall p<0.001 0% 25% 50% 75% 100% Surgical Oncology Neurosurgery Plastic Surgery Other Specialties Core needle biopsy Open biopsy Fine needle aspiration Stereotactic biopsy No biopsy performed Don't know Preferred type of biopsy D Figure 2 Preoperative diagnostics performed. A) Overall preoperative diagnostics per surgical subspecialty B) Percentage per surgical subspecialty of different imaging techniques used C) Use of preoperative staging modalities per surgical subspecialty D) Preferred type of biopsy per surgical subspecialty. p values: ***≤ 0.001. Radiotherapy Opinions of indications for the use of radiotherapy in localized disease did not differ significantly among surgical subspecialties (all p>0.05, Figure 4 ). While opinions were divided on whether to use radiotherapy in tumors 5-10cm of size, 78% of respondents would advise radiotherapy in patients with tumors larger than 10cm of size. Microscopic positive margin was regarded as an indication for radiotherapy by the majority of respondents (86%), and by an even larger proportion of the surgical oncologists (96%). Forty-three percent of respondents are of the opinion that radiotherapy is routinely indicated in any localized MPNST. Preferred sequence of radiotherapy in any localized MPNST differed significantly among surgical subspecialties (p<0.05). Surgical oncologists preferred neoadjuvant administration (72%), while other subspecialties either preferred adjuvant administration (36-53%) or had no preference (21-43%).