Dr Singh on Multidisciplinary Brain Tumor Management Strategies

“Brain tumor management is complex. It’s important to have neurosurgery, radiation oncology, neuro-oncology, and, if you're in the brain metastasis–based [field of treatment], medical oncology involved as well.”

Raj Singh, MD, a radiation oncologist at the Eugene M. and Christine E. Lynn Cancer Institute, part of Baptist Health, discussed the importance of multidisciplinary collaboration for the treatment of patients with brain tumors in light of World Brain Tumor Day, which is observed annually on June 8.

Singh began by emphasizing the clinical complexity inherent in brain tumor management, underscoring the critical importance of a multidisciplinary team composed of neurosurgery, radiation oncology, neuro-oncology, and medical oncology specialists. He detailed the decision-making process involved in determining the appropriateness of biopsy, surgical resection, or debulking, noting that these determinations are primarily dictated by the assessments of neurosurgical colleagues regarding technical feasibility.

Singh highlighted that when a complete resection is not possible and debulking is planned, it is imperative that patients are integrated into the radiation, medical, and neuro-oncology workflows as rapidly as possible. This coordination is essential to ensure that adjuvant therapy is initiated without delay, particularly in cases where tumor remnants are known to be left behind, he said.

Furthermore, Singh focused on the management of brain metastases, noting the essential role of medical oncology. Singh explained that the management of intracranial lesions must be carefully weighed against the response or progression of disease elsewhere in the body. According to Singh, the status of extracranial disease frequently informs the initial surgical approach.

Singh cautioned against viewing the brain as an isolated entity, stressing the need to consider the competing risks to a patient’s long-term quality of life and overall performance status. The objective, as Singh noted, is to determine an optimal approach that balances the risks and benefits of surgical intervention, ensuring the patient is not left in a worse condition long-term.

A key finding highlighted by Singh was the effect of rapidly evolving systemic therapy agents on upfront management. Singh provided the example of craniopharyngioma, a rare tumor subtype where targeted therapy can now be used. Singh noted that involving neuro-oncology in early discussions for such cases might spare patients from unnecessary additional local therapies. He concluded that as the understanding of brain tumor biology grows more complex, the involvement of all stakeholders is vital to ensure that no critical component of the treatment puzzle is overlooked during the initial management phase.