Tumor Board provides expert multidisciplinary review of brain tumor cases

Doctors watch presentation

This week, we are fortunate to hear from Eric LaPresto, Director of Systems and Information, who provides an overview of one of the most unique aspects of our Brain Tumor Center, the Tumor Board.

The care and treatment for many brain tumor patients is often straightforward and uncomplicated. For these patients, the physicians and nurses providing medical care can prescribe well-known treatment plans with expected results. Some patients, however, may have more complicated medical conditions and the prescription of a standard treatment plan may not always be recommended.

For these patients, the UC Brain Tumor Center holds a weekly group meeting to discuss the medical management of complicated brain tumor cases. This specially designated meeting, commonly known as the Tumor Board, brings together all brain tumor physicians, nurses, and allied health professionals for two hours every week in a cohesive and focused setting, where they are removed from their often interrupted daily routine of surgery, clinics, and hallway meetings. The group can freely review all treatment regimens, from traditional therapies to new, state-of-the-art techniques, in a collaborative setting that encourages open advice and constructive criticism, with the goal of determining the best treatment plan for each patient.

The Experts

Making a world class medical recommendation for a brain tumor patient requires the expertise of healthcare professionals from many medical specialties. The multidisciplinary Tumor Board team is comprised of experts from the UC Brain Tumor Center, the UC Health University Hospital, and UC Physicians, who individually specialize in the fields of neurosurgery, neurology, neuroradiology, radiation oncology, hematology and oncology, neuropathology, otolaryngology, endocrinology, and ophthalmology. Clinical trials specialists, visiting professors, and medical residents and fellows also contribute to the discussions.

At each meeting of the Tumor Board, a specially designated physician is selected to moderate the discussion of all patients. The moderating physician, or moderator, changes weekly, and is customarily selected from the field of neurosurgeons, radiation oncologists, and hematology/oncologists. The moderator’s job is not simple, as they must encourage open comment from a broad representation of specialties while simultaneously guiding the discussion toward the best recommendation. Since multiple cases are reviewed at each Tumor Board, the moderator must control the pace of discussion to allow sufficient time for each and every patient.

Medical Imaging

A cornerstone in the treatment of brain tumors is medical imaging. From MRI and CT to PET and SPECT, the imaging of patients’ brain tumors lays the foundation for prescribing the proper medical treatment and provides the means for gauging their response to treatment. Proper imaging can help to determine the type of tumor, the location of the tumor, and subsequently, the most appropriate treatment.

In today’s digital world, most medical imaging is recorded to a computer or a Compact Disc (CD). Compared to the large x-ray films of old, the use of computers and CDs for viewing and storing medical images has numerous advantages. For the Tumor Board, it is undoubtedly the ability to display these images from a computer to a large, conference-sized projector screen that makes the difference. Like the screen in a movie theater, every image is clearly visible for each member of the tumor board. Additionally, state of the art computer programs now let us easily compare imaging studies taken at different times and from different places. By positioning these imaging studies side- by-side on a computer monitor, tumor changes over time or between modalities can be observed. This ability to review images from different times and different sources is critical when a patient has been to more than one hospital and has had multiple imaging sessions over their course of their treatment.

But simply displaying the image studies to the group is not the goal. Instead, the Tumor Board receives the expert advice from a neuroradiologist, a specialist with expert training in the interpretation of medical imaging of the brain, spine, and peripheral nerves. For each patient, the neuroradiologist reviews the medical images interactively with the group. Usually, this consists of images taken from multiple CDs and multiple dates. The neuroradiologist will interactively point out significant details, take measurements, and may recommend which imaging studies should be taken for the next treatment cycle.

Recommendation

Based upon the review of medical imaging, the patient’s past history, and the patient’s current condition, the Tumor Board will formulate a recommended treatment plan. For example, the plan may call for surgery, either as a needle biopsy, tumor resection, or tumor debulking, radiation therapy, chemotherapy, additional imaging, additional lab work, or referral to other medical professionals. The enrollment on a clinical trial is considered as well. In some cases, the recommendation may even be to wait and observe the behavior of a tumor. These recommendations will be communicated back to the patient and their referring physician. In all cases, the recommendation will be based upon current medical expertise and scientific advances. Over time and due to medical innovations, the recommendations from Tumor Board will vary.

Second Opinion

Not all brain tumor patients have a complicated medical history that requires a group discussion at a Tumor Board meeting. Their treatment plans may be straightforward and follow an expected course of action, with predictable responses to surgery, chemotherapy, or radiation. Despite this predictability, the fears of some patients or their families may not be alleviated. Likewise, patients with newly diagnosed tumors or patients at other institutions may be interested in getting a second opinion regarding the treatment of their brain tumor. For these reasons, the UC Brain Tumor Center can offer a review of their medical history and recommend a treatment plan.

If patients or physicians wish to request a review, or if you would like more information on the UC Brain Tumor Center Tumor Board, please contact us at 866-941-8264 or via the web at http://www.ucbraintumorcenter.com/contact/. Current patients of the UC Brain Tumor Center may also contact their physicians to request a review. Eric LaPresto Director, Systems and Information UC Brain Tumor Center

Eric LaPresto Director, Systems and Information UC Brain Tumor Center

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