Abstract
Background Malignant peripheral nerve sheath tumors (MPNSTs) are rare and aggressive soft tissue sarcomas (STS) that, because of their origin, are operated by several surgical subspecialties. This may cause differences in oncologic treatment recommendations based on presentation. This study investigated these differences both within and between subspecialties. Methods A survey was distributed among several (inter)national surgical societies. Differences within and between subspecialties were analyzed by χ2-tests. Results In total, 30 surgical oncologists, 30 neurosurgeons, 85 plastic surgeons, and 29 “others” filled out the survey. Annual caseload, tumor sites operated, and fellowship training differed significantly between subspecialties. While most surgeons agreed upon preoperative use of MRI, the use of radiological staging and FDG-PET use differed between subspecialties. Surgical oncologists agreed upon core needle biopsies as an ideal type of biopsy while other subspecialties differed in opinion. On average, 53% of surgeons always consider preservation of function preoperatively, but 42% would never perform less extensive resections for function preservation. Respondents agreed that radiotherapy should be considered in tumor sizes >10 cm, microscopic, and macroscopic positive margins. A preferred sequence of radiotherapy administration differed between subspecialties. There was no consensus on indications and sequence of administration of chemotherapy in localized disease. Conclusion Surgical oncologists generally agree on preoperative diagnostics; other subspecialties do not. Considering the preservation of function differed among all subspecialties. Surgeons do agree on some indications for radiotherapy, yet the use of chemotherapy in localized MPNSTs lacks consensus. A preferred sequence of multimodal therapy differs between and within surgical subspecialties, but surgical oncologists prefer neoadjuvant radiotherapy.
Highlights
Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft tissue sarcomas (STS) that can occur at any anatomical site [1]
174 respondents filled out the survey: 30 surgical oncologists, 30 neurosurgeons, 85 plastic surgeons, and 29 surgeons from other surgical subspecialties
Fellowship experience differed between subspecialties (p < 0.001); surgical oncologists commonly had completed a sarcoma fellowship (85%), while other respondents more commonly did a fellowship in peripheral nerve surgery (32–56%). e highest caseloads were performed by surgical oncologists (p < 0.001). e majority of respondents operated extremity site tumors (87%, p > 0.05), but most other tumor sites differed between surgical subspecialties
Summary
Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft tissue sarcomas (STS) that can occur at any anatomical site [1]. While surgical oncologists consider MPNSTs as part of their sarcoma population requiring radical excision [17, 18], plastic surgeons and neurosurgeons operating peripheral nerve lesions regard them as a malignant form of nerve sheath tumor, which is treated by nerve-sparing surgery [19, 20] Such a difference in perspective could affect clinical decision-making. Is study investigated treatment recommendations and differences in opinions between surgical subspecialties treating MPNSTs on preoperative diagnostics, surgical decisionmaking, and the use of multimodal therapy in localized MPNSTs. Malignant peripheral nerve sheath tumors (MPNSTs) are rare and aggressive soft tissue sarcomas (STS) that, because of their origin, are operated by several surgical subspecialties. A preferred sequence of multimodal therapy differs between and within surgical subspecialties, but surgical oncologists prefer neoadjuvant radiotherapy
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