Martin Enrico, Slooff Willem-Bart M, van Houdt Winan J, van Dalen Thijs, Verhoef Cornelis, Coert J Henk
Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Department of Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands.
Sarcoma. 2020 Feb 27;2020:6406439. doi: 10.1155/2020/6406439. eCollection 2020.
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.
A survey was distributed among several (inter)national surgical societies. Differences within and between subspecialties were analyzed by -tests.
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.
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.
恶性外周神经鞘瘤（MPNSTs）是罕见且侵袭性强的软组织肉瘤（STS），因其起源部位，需多个外科亚专业进行手术治疗。这可能导致基于临床表现的肿瘤治疗建议存在差异。本研究调查了亚专业内部和之间的这些差异。
向多个（国际）外科协会发放了调查问卷。通过t检验分析亚专业内部和之间的差异。
共有30名外科肿瘤学家、30名神经外科医生、85名整形外科医生和29名“其他”医生填写了调查问卷。亚专业之间的年病例量、手术的肿瘤部位和专科培训存在显著差异。虽然大多数外科医生在术前使用MRI方面达成共识，但放射学分期和FDG-PET的使用在亚专业之间存在差异。外科肿瘤学家一致认为粗针活检是理想的活检类型，而其他亚专业意见不同。平均而言，53%的外科医生术前总是考虑保留功能，但42%的医生绝不会为保留功能而进行范围较小的切除术。受访者一致认为，肿瘤大小>10 cm、显微镜下和肉眼可见切缘阳性时应考虑放疗。放疗给药的首选顺序在亚专业之间存在差异。对于局限性疾病化疗的适应证和给药顺序没有共识。
外科肿瘤学家在术前诊断方面总体上达成共识；其他亚专业则不然。在保留功能方面，所有亚专业的看法不同。外科医生在放疗的一些适应证上确实达成了共识，但在局限性MPNSTs中使用化疗缺乏共识。多模式治疗的首选顺序在外科亚专业之间和内部存在差异，但外科肿瘤学家更喜欢新辅助放疗。
