Multidisciplinary Practice Patterns and Barriers to Preoperative Radiotherapy for Soft Tissue Sarcoma: A National Multicenter Survey

Background: Preoperative radiotherapy (pre-opRT) is an established component of multimodal treatment for soft tissue sarcoma (STS), offering advantages in margin control and long-term functional outcomes. Its integration into clinical practice depends on effective multidisciplinary decision-making between surgical and radiation oncology teams. We conducted a national multicenter survey to evaluate practice patterns, multidisciplinary coordination, and barriers to pre-opRT implementation in China. Methods: A cross-sectional survey was conducted across 25 provinces, including 123 clinicians (67 radiation oncologists and 56 surgeons). The questionnaire assessed institutional multidisciplinary team (MDT) structure, pre-opRT utilization, and perceived barriers. Associations between MDT structure and pre-opRT use were explored. Results: Pre-opRT utilization was low: 30% of clinicians reported no use, and over 60% applied pre-opRT in fewer than 10% of eligible patients. Surgeons identified postoperative wound complications as the primary concern, while non-core surgeons frequently reported limited access to sarcoma-specialized radiation oncologists. Radiation oncologists highlighted difficulty achieving cross-disciplinary agreement. Clinicians practicing within structured MDT settings were significantly more likely to report higher pre-opRT utilization (P = 0.019). Despite limited adoption, more than 70% of respondents recognized the clinical value of pre-opRT. Conclusion: The use of pre-opRT for STS is shaped not only by clinical considerations but also by the effectiveness of multidisciplinary coordination. Strengthening MDT structures, addressing surgical concerns regarding wound complications, and improving cross-specialty communication may facilitate more consistent integration of pre-opRT into sarcoma care.