Tag: fostering-multidisciplinary-collaboration-in-brain-tumor-management

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.

Managing brain tumors is a remarkably complex endeavor that requires not only expert knowledge but also a well-orchestrated team effort. Dr. Jennifer Moliterno, a leading figure in neurosurgical oncology, underscores the importance of a collaborative approach involving neurosurgeons, medical oncologists, and radiation oncologists to optimize treatment outcomes. Brain tumors are no monolith; their treatment success hinges on understanding their diverse histologies, precise locations, and unique molecular profiles. This multifaceted nature means that a personalized and dynamic method combining surgery, radiation, and systemic therapies is essential to provide the best care.

At the forefront of this approach at Yale School of Medicine’s Neurosurgical Oncology division, Dr. Moliterno leads several key programs focused on pioneering treatment and patient care innovation. Beyond just her surgical skills, she champions the integration of cutting-edge techniques such as whole-exome sequencing, offering a molecular-level insight into each tumor. This genomic data reveals insights that transcend traditional imaging and pathology, enabling the team to tailor treatments that go beyond the standard care. It is this precision medicine philosophy, utilizing personalized genetic information, that exemplifies the next generation of neuro-oncology. By leveraging these molecular clues, the multidisciplinary brain tumor and precision brain tumor boards at Yale can recommend therapies tailored specifically to the genetic makeup of a patient’s tumor.

The collaboration doesn’t come together haphazardly but through carefully structured tumor board discussions where specialists deliberate over each patient’s unique case. Dr. Moliterno highlights how decisions on the timing and sequencing of surgery, radiation, and systemic therapy require a delicate balance of factors. They consider the extent of tumor resection possible—aiming to remove as much of the tumor as safely feasible—while also evaluating the patient’s postoperative neurological function. These decisions also involve weighing the risks and benefits of adjuvant therapies such as radiation and chemotherapy to minimize harm while maximizing treatment efficacy. Such boards are a prime example of evidence-based medicine meeting personalized care, where the collective wisdom of multiple specialists improves patient outcomes.

One particularly fantastic aspect of Dr. Moliterno’s institution is the seamless transition of patients between specialists. After surgical resection, the neuro-oncologist assumes the role of “quarterback,” coordinating the patient’s ongoing care plan, including the integration of systemic therapies. Meanwhile, radiation oncologists join the team strategy, ensuring treatments are synchronized and optimized. This smooth continuum of care exemplifies what many hospitals strive for but few achieve at this level of precision and coordination. It removes the potential pitfalls of fragmented care and fosters a patient-centered environment, where everybody is aligned on a unified treatment strategy.

In addition to the collaborative clinical approach, the use of next-generation sequencing technologies at Yale represents a remarkable leap forward in brain tumor care. Whole-exome sequencing—examining all protein-coding genes in the human genome—provides an unprecedented depth of tumor characterization. This data guides innovative therapeutic strategies, exploring avenues beyond conventional radiation and chemotherapy. For instance, some tumor genetic profiles may indicate susceptibility to novel targeted treatments or immunotherapies, opening doors to clinical trials or off-label uses supported by molecular rationale. As the field of neuro-oncology continues to evolve, embracing such comprehensive molecular analyses not only personalizes therapy but also fuels research that may in time transform the prognosis for what have been historically devastating conditions.

#BrainTumor #Neurosurgery #PrecisionMedicine #OncologyCollaboration #CancerTreatment #MolecularGenetics #NeuroOncology