Enrico Martin

96 Chapter 5 0% 25% 50% 75% 100% Tumor size 5−10cm Tumor size >10cm Microscopic margin Macroscopic margin Always SurgicalOncology Neurosurgery PlasticSurgery OtherSpecialties Indications for radiotherapy A Overall p=0.005 0% 25% 50% 75% 100% Surgical Oncology Neurosurgery Plastic Surgery Other Specialties Never Radiotherapy Neoadjuvant Radiotherapy Adjuvant Radiotherapy No preference Preferred sequence of radiotherapy B 0% 25% 50% 75% 100% Tumor size 5−10cm Tumor size >10cm Microscopic margin Macroscopic margin Always Indications for chemotherapy C Overall p=0.185 0% 25% 50% 75% 100% Surgical Oncology Neurosurgery Plastic Surgery Other Specialties Never Chemotherapy Neoadjuvant Chemotherapy Adjuvant Chemotherapy No preference Preferred sequence of chemotherapy D Figure 4 Use of multimodal therapy. A) Percentage per surgical subspecialty of indications for radiotherapy B) A preferred sequence of radiotherapy per surgical subspecialty C) Percentage per surgical subspecialty of indications for chemotherapy D) A preferred sequence of chemotherapy per surgical subspecialty. p values: *≤ 0.05, **≤ 0.01. Discussion In patients who are referred for soft tissue tumors that are possibly MPNSTs, the reported use of preoperative imaging studies and biopsies differs between surgical subspecialties; the vast majority of surgical oncologists routinely perform both. Some surgical considerations such as extent of resection margins for preservation of function in selected cases differ within surgical subspecialties. Moreover, assumed indications for the use of radiotherapy and chemotherapy in localized MPNST differ among surgical subspecialties, as well as their ideal timing of administration. Preoperative diagnostics in MPNST Ideally, MPNSTs are resected with a wide margin to obtain an R0 margin. 4,10,21,22 As a result, surgery can be very disabling, underlining the need for correct preoperative diagnosis as benign nerve sheath tumors can be resected without margins. Additionally, obtaining a preoperative diagnosis facilitates the opportunity to administer preoperative radiotherapy or chemotherapy. Therefore, guidelines for