The ongoing study for SST (Eastern Cooperative Oncology Group, phase II, including the combination of cisplatin and etopo-side and radiotherapy [45 Gy] before surgery) addresses this issue. But whether the chemoradiation regime will improve resectability figures is question-able. Proper preoperative staging is the cornerstone in any patient who is candidate for oncologic surgery. All patients in the present study underwent CT scanning of the whole thorax and the abdomen. The primary tumor was investigated to establish its relationship to the adjacent structures and to exclude ingrowths in the nerve plexus. 
CT scanning provided anatomic information concerning operability, and the use of IV contrast allowed evaluating compression or ingrowths in the vascular structures Kamagra Australia. This is important for staging procedures in order to exclude adrenal metastases and pulmonary metastases. Whether MRI is superior to CT scanning for preoperative planning cannot be concluded from our study; in case there is doubt about resectability, we always perform MRI. In a study conducted in 1989, MRI proved superior to CT scanning; because in that study, all R1 resected patients relapsed, it may be important to perform MRI in all cases. However, in the last decades enormous improvements have been made in both modalities and a comparison between multislice CT scanning and MRI has not yet been made.
Combined radiotherapy and surgery should always be considered in patients with SSTs. In experienced centers, this treatment does not result in an increased complication rate. In the present study, use of intraoperative radiotherapy resulted in a local relapse-free survival of at least 76%, which probably led to an improvement in quality of life, even in patients with a limited life expectancy. Improvement of overall survival in SST is currently studied in ongoing trials with concomitant radiotherapy and chemotherapy. Also, attention is paid to morbidity, functionality, and analgesic requirements. Improvement of staging and preoperative planning will also improve proper patient selection.
