{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:59:17Z","timestamp":1790765957626,"version":"4.1.0"},"reference-count":16,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Malignant peripheral nerve sheath tumors (MPNSTs) are rare, aggressive sarcomas with poor overall survival (OS). Radiotherapy timing is extrapolated from other soft\u2010tissue sarcomas, and no prior MPNST\u2010specific analysis has formally tested whether neoadjuvant radiotherapy (NRT) effects are modified by metastatic status. We evaluated NRT's association with R0 resection and OS by metastatic status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective cohort of MPNST patients in the National Cancer Database (2005\u22122023). Multivariable logistic regression evaluated NRT and R0 resection. Cox proportional hazards models tested an NRT\u2010by\u2010metastatic status interaction, with hospital\u2010level frailty terms addressing inter\u2010facility correlation. Propensity score matching (1:1) reduced confounding. Sensitivity analyses addressed guarantee\u2010time bias and confounding. Causal mediation evaluated R0 as a mediator of the NRT\u2212survival relationship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 2241 patients, 24.2% received NRT. NRT increased the odds of R0 resection (OR 2.17, 95% CI 1.60\u22122.98;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) but was not associated with improved survival overall. The NRT\u2010survival association was modified by metastatic status (interaction\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001): metastatic patients receiving NRT had better survival (matched HR 0.41, 95% CI 0.23\u22120.72;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004), whereas no survival benefit was seen in localized disease (worse in some analyses). This signal was consistent across guarantee\u2010time sensitivity analyses but was not mediated by margins.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>NRT improves the odds of R0 resection in MPNST, but improved margins do not yield a uniform survival benefit. The NRT\u2010survival association is modified by metastatic status; the metastatic signal, though robust to guarantee\u2010time bias, was not mediated by margins and rests on a small subgroup. These findings are hypothesis\u2010generating and warrant a prospective study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70400","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:08:47Z","timestamp":1790762927000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metastatic Status Modifies the Survival Association of Neoadjuvant Radiotherapy in Malignant Peripheral Nerve Sheath Tumors: A Nationwide Analysis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9304-0565","authenticated-orcid":false,"given":"Shilp","family":"Shah","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1636-7642","authenticated-orcid":false,"given":"Shivam","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas N.","family":"Vattipally","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Barreto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taha","family":"Khalilullah","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie Alfonzo","family":"Horowitz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7900-5151","authenticated-orcid":false,"given":"Liam P.","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"Dardick","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jawad M.","family":"Khalifeh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanxuan","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5355-2683","authenticated-orcid":false,"given":"Nicholas","family":"Theodore","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA"},{"name":"Department of Neurosurgery University of Arizona College of Medicine Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lubelski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/children9010038"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.39.5.311"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zrae024"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-020-02036-x"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25149"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/noajnl\/vdae067"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.25910"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-017-6019-8"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-015-1974-6"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1731464"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13153851"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2015.08.012"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjorl.2025.101702"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14071804"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noae123"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11912-009-0045-z"}],"container-title":["Journal 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