Optimal management of brain tumors necessitates a cohesive and collaborative approach involving neurosurgeons, medical oncologists, and radiation oncologists, according to Jennifer Moliterno, MD, FAANS. The inherent complexities in treating patients with diverse tumor types demand a nuanced understanding of how to strategically integrate surgery, radiation therapy, and systemic therapies to maximize patient outcomes.
Moliterno, chief of Neurosurgical Oncology; clinical director of the Chênevert Family Brain Tumor Center; director of the Susan Beris, MD, Neurosurgical Oncology Program; surgical director of the Facial Pain and Spasm Program; and director of Neurosurgical Oncology Fellowship, Neurosurgical Oncology at Yale School of Medicine, spoke with CancerNetwork® about invaluable insights into fostering effective collaboration among these specialties.
She addressed the critical considerations in determining the ideal timing and sequencing of different treatment modalities for various brain tumors. The unique characteristics of each tumor type, including its histology, location, and molecular profile, influence the collaborative decision-making process.
Moliterno further delved into the specific nuances of coordinating surgical resection with adjuvant therapies. She discussed how factors such as the extent of resection, postoperative neurological status, and the anticipated benefits and risks of subsequent radiation and systemic treatments are carefully weighed in multidisciplinary tumor boards.
Transcript:
One of the unique things about [our institution], in addition to our expertise for maximizing and safely improving the extent of resection, is that all our tumors undergo what we call whole-exome sequencing so we can understand the tumor from a molecular genetic perspective. We’re unique with that comprehensive next-generation sequencing technique that we do for all of our patients who have surgery here. We can then use that information in our multidisciplinary group. I lead the multidisciplinary brain tumor board, as well as the precision brain tumor board, where, after surgery, we can then use those molecular data for each person to personalize more precise treatment. A lot of times, there’s the standard of care for glioma; for instance, with radiation and with chemotherapy. Sometimes, there can be opportunities for more personalized treatment. That’s where we then coordinate with our neuro-oncologists and our radiation oncologists. We do have a seamless team that allows us to then transition the patient’s care from the surgeon, then to have the [neuro-oncologist] and medical doctor as the quarterback for the patient. Then, [we can] incorporate the radiation doctors as well.
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