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Abstract：
OBJECTIVE: 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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
目标：多学科肿瘤委员会（MTB）整合临床，分子，和放射学信息，并促进神经肿瘤护理的协调。在COVID-19大流行期间，我们的MTB过渡到虚拟和多机构形式。我们假设这种扩展将允许专家审查具有挑战性的神经肿瘤学病例，并有助于对进入专业中心有限的患者进行护理。
方法：我们回顾了在2020年4月3日至2021年3月3日期间持有的虚拟MTB的记录。收集的数据包括潜在临床影响的测量，包括转介观察性或治疗性研究，专门的神经病理学分析转介，以及分子检查结果是否导致诊断和/或指导管理建议的改变。
结果：在25次会议中，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。在21％（n=9）中，根据在NIH获得的分子谱分析和36％（n=15）的分子发现指导管理，对诊断进行了更改或改进。向31%(n=13)的人提供了临床试验建议，观察性NCI自然史研究的入学率为21%(n=9)，NIH的神经病理学回顾和分子检测达到17%(n=7)，都收到了管理建议。
结论：虚拟多机构MTB能够远程专家审查中枢神经系统肿瘤。我们建议将它们作为一种策略，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，并作为研究的预筛查工具。先进的分子检测是获得精确诊断的关键，发现潜在的可操作目标，和指导管理。
方法：我们回顾了在2020年4月3日至2021年3月3日期间持有的虚拟MTB的记录。收集的数据包括潜在临床影响的测量，包括转介观察性或治疗性研究，专门的神经病理学分析转介，以及分子检查结果是否导致诊断和/或指导管理建议的改变。
结果：在25次会议中，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。在21％（n=9）中，根据在NIH获得的分子谱分析和36％（n=15）的分子发现指导管理，对诊断进行了更改或改进。向31%(n=13)的人提供了临床试验建议，观察性NCI自然史研究的入学率为21%(n=9)，NIH的神经病理学回顾和分子检测达到17%(n=7)，都收到了管理建议。
结论：虚拟多机构MTB能够远程专家审查中枢神经系统肿瘤。我们建议将它们作为一种策略，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，并作为研究的预筛查工具。先进的分子检测是获得精确诊断的关键，发现潜在的可操作目标，和指导管理。
