Enrico Martin

99 Oncological treatment considerations suggest MPNST can respond well to chemotherapy, but exact populations that may respond are to be elucidated. 44,45 More clinical studies are warranted to find tumor- tailored non-cytotoxic treatments, alas, so far none have been proven effective in MPNSTs. 46 As the debate on exact role for multimodal therapy in localized disease is still evolving, advantages and disadvantages are to be discussed with patients after general discussion in a multidisciplinary tumor board. Several STS calculators have been proposed useful for decision-making. 47,48 Again, by including both oncological and reconstructive surgeons when planning patient treatment for localized disease an ideal strategy can be obtained for the timing of multimodal therapy as opposed to oncological resection and possible functional reconstruction. Strengths and limitations Limitations to this study are partially inherent to the survey methodology. Respondent bias should always be taken into account as only interested surgeons will fill out the survey. Furthermore, selection bias may be present as we restricted our survey distribution to a certain list of surgical societies, thereby excluding physicians that are not members of these societies. This study is however strengthened by the combination of respondents with experience in both sarcoma and peripheral nerve surgery. As patients will present themselves to several surgical subspecialties it is important that knowledge and experience are exchanged, more so when practice variation is present. Partially, as several elements of MPNST treatment have not been proven by high-level evidence, of which some will likely never be because of their low incidence. Future studies should be encouraged in combining data from several subspecialties and to further explore the ideal combination of surgical treatment and function preservation and the role of multimodal treatment. Multidisciplinary approaches are essential for optimal treatment of MPNSTs, possibly including collaboration of surgical oncologists, nerve surgeons, and reconstructive surgeons. In turn, consensus guidelines among all specialties treating MPNSTs can and should be made. Conclusion While a consensus among surgical oncologists is more apparent in preoperative diagnostics, this differs between surgical subspecialties. Some disagreement exists as well within subspecialties on less extensive resections in selected cases for function preservation. While surgeons agree on some indications for radiotherapy, preferred sequence of radiotherapy differed between surgical subspecialties and within subspecialties other than oncologic surgery. Chemotherapy seems less popular in localized disease and indications for its use lack consensus among surgeons. Differences between surgical subspecialties are likely caused by specialty bias and combining knowledge between surgical subspecialties may further ameliorate patient outcomes. 5