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.

中文翻译：

---

虚拟多机构肿瘤委员会：罕见中枢神经系统肿瘤的个性化诊断和管理策略

目的

多学科肿瘤委员会 (MTB) 整合临床、分子和放射学信息，促进神经肿瘤护理的协调。在 COVID-19 大流行期间，我们的 MTB 转变为虚拟的多机构形式。我们假设这种扩展将使专家能够对具有挑战性的神经肿瘤病例进行审查，并有助于对进入专业中心的机会有限的患者进行护理。

方法

我们回顾性审查了 2020 年 4 月至 2021 年 3 月期间举行的虚拟 MTB 记录。收集的数据包括潜在临床影响的衡量，包括转诊观察或治疗研究、转诊专门的神经病理学分析，以及分子发现是否导致诊断和/或指导管理建议的改变。

结果

在 25 场会议中，32 位发言者讨论了 44 个案例。大约一半（n  = 20；48%）涉及罕见的中枢神经系统（CNS）肿瘤。21% ( n  = 9) 的诊断根据 NIH 获得的分子谱进行了改变或完善，36% ( n  = 15) 的分子发现指导了治疗。31%（ n = 13）提供了临床试验建议，21%（ n = 9） 参加了观察性 NCI 自然史研究，17%（ n  = 7） 参加了 NIH 的神经病理学审查和分子检测，以及收到管理建议。

结论

虚拟多机构 MTB 使专家能够对中枢神经系统肿瘤进行远程审查。我们建议将其作为一项战略，以促进专业中心的专家意见，特别是对于罕见的中枢神经系统肿瘤，帮助减轻患者护理的地理障碍，并作为研究的预筛选工具。先进的分子检测是获得精确诊断、发现潜在可行目标和指导管理的关键。