Tumor Board’s ‘Team Opinion’ Proves Its Value Each Week

Three scenes from the board

Scenes from Tumor Board: Ronald Warnick, MD, left, and Philip Theodosopoulos, MD, right, discuss a patient’s brain scans, center. Photos by Cindy Starr / Mayfield Clinic.

For patients who are treated at the Brain Tumor Center at the University of Cincinnati Gardner Neuroscience Institute, a part of UC Health, there’s no reason to ask for a second opinion. It’s part of the package. So is a third opinion, and a fourth, and maybe even 5th, 6th and 7th.

The multiple opinions are delivered during a weekly multidisciplinary conference known as “Tumor Board”and then synthesized into a recommendation for each patient.

During the Tumor Board roundtable, doctors from several sub-specialties examine the scans and history of the Brain Tumor Center’s patients. The discussions are thoughtful and animated, as each physician brings his or her own unique perspective to each individual patient’s situation. The physicians include specialists in radiation oncology, neurosurgery, neuro-oncology, otolaryngology, physical medicine and rehabilitation, restorative medicine, neuropathology, and neuroradiology.

Learn more about Tumor Board and watch the brain tumor team discuss a real brain tumor case on the
UC Health YouTube channel >>

The value of bringing together so many experts cannot be overestimated. In several instances, the team has determined that patients who were told they had a brain tumor in fact did not have a tumor. These patients clearly benefited from the combined expertise of many specialists, rather than having their treatment hinge on a single radiologist’s report or an individual neurosurgeon’s decision.

Ronald Warnick, MD, Professor of Neurosurgery and Medical Director of the Brain Tumor Center, describes a case that proves the value of a preoperative review at Tumor Board.

“We recently evaluated a young man who had undergone successful treatment of a glioblastoma (with surgery, radiation, and chemotherapy) approximately seven years ago. He returned with speech difficulty and was found to have a new enhancing mass in the temporal lobe that was consistent with recurrent glioblastoma. We were planning either a biopsy or surgical resection.

“The patient’s case was then presented at Tumor Board, and the neuroradiologists raised the possibility that this might not be a tumor. They performed a relatively new technique, perfusion MRI, which confirmed that the lesion was actually a stroke. The patient did not require surgery, and the lesion has resolved over time.”

Chris Knueven, a member of the Brain Tumor Center’s Community Advisory Board, recalls his own experience with Tumor Board. “The consensus was to wait and watch the tumor at that point, and I found that reassuring,” says Mr. Knueven, who eventually did require surgery.

The entire process of assessing and treating a patient with a brain tumor typically begins when a patient sends clinical records, x-rays or MRI scans to be reviewed by the Brain Tumor Center team. The team then conducts a preliminary review to determine which of the specialists the patient should see. After the patient has seen the physician, and after any additional scans or tests have been performed, the patient’s case is discussed at Tumor Board.

A neuroradiologist begins each presentation by reviewing the patient’s films and stating the type of tumor the patient has, whether it has recurred, and whether any other abnormality is present. If pathology slides are available from a previous surgery, a neuropathologist presents them and explains the findings.

Then, in a systematic fashion, the Tumor Board moderator solicits recommendations from representatives of each of the center’s primary specialties. A neurosurgeon advises whether surgical intervention is possible; a radiation oncologist advises whether the patient should receive radiation; and a neuro-oncologist states whether chemotherapy is appropriate.

The patient is also screened for clinical trials available through the UC Brain Tumor Center.  At the conclusion of the discussion, a recommendation is always given: a strategy for treatment or a decision to perform another test.

— Cindy Starr

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