Virtual multi-institutional tumor board: a strategy for personalized diagnoses and management of rare CNS tumors

Authors

• James L. Rogers, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
• Thomas Wall, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
• Alvina A. Acquaye-Mallory, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
• Lisa Boris, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
• Yeonju Kim, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
• Kenneth Aldape, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
• Martha M. Quezado, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
• John A. Butman, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
• James G. Smirniotopoulos, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
• Huma Chaudhry, Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
• Christina I. Tsien, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
• Prashant Chittiboina, Surgical Neurology Branch,, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
• Kareem Zaghloul, Surgical Neurology Branch,, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA.
• Orwa Aboud, Department of Neurology and Neurological Surgery, UC Davis Comprehensive Cancer Center, 4860 Y Street, Sacramento, CA, 95817, USA.
• Nicholas G. Avgeropoulos, Brain and Spine Tumor Program, Orlando Health Cancer Institute, 1400 S. Orange Ave, Orlando, FL, 32806, USA.
• Eric C. Burton, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
• David M. Cachia, Department of Hematology/Oncology, University of Massachusetts, 55 Lake Ave, Worcester, MA, 01655, USA.
• Karan S. Dixit, Lou and Jean Malnati Brain Tumor Institute, Northwestern University Feinberg School of Medicine, 675 N St Clair St, Chicago, IL, 60611, USA.
• Jan Drappatz, Department of Neurology, University of Pittsburgh Medical Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA.
• Erin M. Dunbar, Piedmont Brain Tumor Center, Piedmont Atlanta Hospital, Atlanta, GA, 2001 Peachtree St30309, USA.
• Peter Forsyth, Department of Neuro-Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
• Edina Komlodi-Pasztor, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
• Jacob Mandel, Department of Neurology, Baylor College of Medicine, 7200 Cambridge St, Houston, TX, 77030, USA.
• Byram H. Ozer, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
• Eudocia Q. Lee, Center for Neuro-Oncology, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
• Surabhi Ranjan, Department of Neurology, Cleveland Clinic Florida, Weston Hospital, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, US.
• Rimas V. Lukas, Lou and Jean Malnati Brain Tumor Institute, Northwestern University Feinberg School of Medicine, 675 N St Clair St, Chicago, IL, 60611, USA.
• Margarita Raygada, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD, 20892, USA.
• Michael E. Salacz, Department of Hematology and Medical Oncology, MD Anderson Cancer Center at Cooper, Cooper University Health Care, Two Cooper Plaza, Camden, NJ, 08103, USA.
• Matthew A. Smith-Cohn, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd, Bethesda, MD, 20892, USA.
• James Snyder, Hermelin Brain Tumor Center, Henry Ford Cancer Institute, 2800 W Grand Blvd, Detroit, MI, 48202, USA.

Document Type

Article

Abstract

PURPOSE: Multidisciplinary tumor boards (MTBs) integrate clinical, molecular, and radiological information and facilitate coordination of neuro-oncology care. During the COVID-19 pandemic, our MTB transitioned to a virtual and multi-institutional format. We hypothesized that this expansion would allow expert review of challenging neuro-oncology cases and contribute to the care of patients with limited access to specialized centers. METHODS: We retrospectively reviewed records from virtual MTBs held between 04/2020-03/2021. Data collected included measures of potential clinical impact, including referrals to observational or therapeutic studies, referrals for specialized neuropathology analysis, and whether molecular findings led to a change in diagnosis and/or guided management suggestions. RESULTS: During 25 meetings, 32 presenters discussed 44 cases. Approximately half (n = 20; 48%) involved a rare central nervous system (CNS) tumor. In 21% (n = 9) the diagnosis was changed or refined based on molecular profiling obtained at the NIH and in 36% (n = 15) molecular findings guided management. Clinical trial suggestions were offered to 31% (n = 13), enrollment in the observational NCI Natural History Study to 21% (n = 9), neuropathology review and molecular testing at the NIH to 17% (n = 7), and all received management suggestions. CONCLUSION: Virtual multi-institutional MTBs enable remote expert review of CNS tumors. We propose them as a strategy to facilitate expert opinions from specialized centers, especially for rare CNS tumors, helping mitigate geographic barriers to patient care and serving as a pre-screening tool for studies. Advanced molecular testing is key to obtaining a precise diagnosis, discovering potentially actionable targets, and guiding management.

Medical Subject Headings

Humans; Retrospective Studies; Pandemics; Central Nervous System Neoplasms (diagnosis, therapy); Patient Care Team; Referral and Consultation

Publication Date

4-1-2024

Publication Title

Journal of neuro-oncology

E-ISSN

1573-7373

Volume

167

Issue

2

First Page

349

Last Page

359

PubMed ID

38427131

Digital Object Identifier (DOI)

10.1007/s11060-024-04613-6

Recommended Citation

Rogers, James L.; Wall, Thomas; Acquaye-Mallory, Alvina A.; Boris, Lisa; Kim, Yeonju; Aldape, Kenneth; Quezado, Martha M.; Butman, John A.; Smirniotopoulos, James G.; Chaudhry, Huma; Tsien, Christina I.; Chittiboina, Prashant; Zaghloul, Kareem; Aboud, Orwa; Avgeropoulos, Nicholas G.; Burton, Eric C.; Cachia, David M.; Dixit, Karan S.; Drappatz, Jan; Dunbar, Erin M.; Forsyth, Peter; Komlodi-Pasztor, Edina; Mandel, Jacob; Ozer, Byram H.; Lee, Eudocia Q.; Ranjan, Surabhi; Lukas, Rimas V.; Raygada, Margarita; Salacz, Michael E.; Smith-Cohn, Matthew A.; and Snyder, James, "Virtual multi-institutional tumor board: a strategy for personalized diagnoses and management of rare CNS tumors" (2024). Neurology. 1753.
https://scholar.barrowneuro.org/neurology/1753