Enrico Martin

95 Oncological treatment considerations Overall p=0.403 0% 25% 50% 75% 100% Surgical Oncology Neurosurgery Plastic Surgery Other Specialties No Sometimes Yes Consider function preoperatively A Overall p=0.275 0% 25% 50% 75% 100% Surgical Oncology Neurosurgery Plastic Surgery Other Specialties No Sometimes No free margin Perform less extensive resections B Overall p=0.539 0% 25% 50% 75% 100% Surgical Oncology Neurosurgery Plastic Surgery Other Specialties No Sometimes Yes Look for nerve of origin C Overall p=0.291 0% 25% 50% 75% 100% Surgical Oncology Neurosurgery Plastic Surgery Other Specialties No Yes Resecting more nerve may decrease recurrence D Figure 3 Surgical considerations per surgical subspecialty. A) Considering the preservation of function preoperatively B) Performing less extensive resections to preserve function C) Look for originating nerve intraoperatively D) Resecting more nerve may lead to a decrease in recurrences. Chemotherapy Overall, respondents felt that chemotherapy was usually not indicated in localized disease ( Figure 4 ). Only tumor sizes larger than 10cm (54%) and macroscopically positive margins (51%) were regarded as an indication by more than half of all respondents. While tumor sizes 5-10cm was seen as an indication for the use of chemotherapy by 29% of respondents, neurosurgeons and ‘other’ surgical subspecialties more commonly viewed this as an indication for its use (p<0.05). A total of 26% of all respondents were of the opinion that chemotherapy should always be used in localized disease; this differed significantly among surgical subspecialties (p<0.05). Neurosurgeons most commonly recommended the latter (47.4%). Preferred sequence of chemotherapy in any localized MPNST did not differ between surgical subspecialties (p>0.05), but no consensus was present. Overall, 24% of respondents did not see a role for chemotherapy in any localized MPNST. 5