Multidisciplinary Surgical Developments Balance Disease Control With Functional Considerations in Brain Cancer

Advances in surgical brain tumor management are shifting the field toward multidisciplinary collaboration and balance, aiming to maximize tumor control supported by network-based brain mapping, as well as provide patients with greater clarity regarding their disease and treatment trajectories, according to Jonathan H. Sherman, MD, FAANS, FCNS, FACS.

“[It is important to] know that there are major centers like [those] we are creating and have created at Rutgers Cancer Institute that can give patients peace of mind, awareness of what the disease is, and what a brain tumor means,” Sherman said in an interview with OncLive®. “[Knowing that they can go to these centers] in their areas to receive the best treatment like we believe we provide here may give patients and their families peace of mind.”

In the interview, Sherman discussed innovations in surgical brain tumor management, highlighting the importance of balancing oncological and functional outcomes in brain surgery. He also addressed the importance of integrating neuropsychological testing into surgical care and emphasized that multidisciplinary brain cancer management is key for improving patient outcomes.

Sherman is division chief of Neurosurgical Oncology at Rutgers Cancer Institute/RWJBarnabas Health, as well as a professor of neurosurgery at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey.

OncLive: What methodological approaches define the current landscape of surgical brain tumor management?

Sherman: The real goal of surgical brain tumor management is onco-functional balance. The oncology aspect of [treatment] takes function away if we’re not careful, or the tumor can do this on its own. If we have a patient who has a given function going into a surgical procedure, we want to make sure we maintain that function, or perhaps even improve that function, after surgery. With the current surgical adjuncts, and the ones we’re trying to develop, we try to give patients the best chance of maximizing surgical resection by minimizing that morbidity of decreasing their function.

What recent surgical advances have improved brain cancer management?

The biggest advances have come out of the Human Connectome Project, where we have gotten a better understanding of the traditional eloquent areas of the brain like motor and speech, but also the networks that are important to how we interact with life; how we have executive functioning, how we function when we’re not talking and just thinking, how we interact [with each other], and how the brain shifts between those areas. One of the major advances has been identifying those highways in the brain and [seeing] how those highways connect with surface structures, so we can protect those in surgery. We can bring that through our navigation software in the operating room to protect those [surfaces].

Also, with neuropsychological testing, [we have also gained a better] understanding of how these networks correlate to neuropsychology, which is the patient’s way of life, their ability to think, and their functioning. We might be able to test those out. Some of that is happening through active research we’re doing at Rutgers Cancer Institute to incorporate neuropsychological testing in our pre-operative, inter-operative, and post-operative areas, so we know the functions [of certain brain areas] and how to protect those better in surgery.

What is your message for medical oncology colleagues about the importance of collaborating with surgical oncologists when treating patients with brain cancer?

[These advances are creating the need for] a multidisciplinary care model. [We can no longer] just [decide that] a patient might need surgery, and send them right to the neurosurgeon. We have to integrate these modalities and [providers] into our clinics [more than] we used to. I started a multidisciplinary clinic at Rutgers that includes neuropsychology, neuro-oncology, and radiation oncology. That’s not a novel concept, but [we wanted] to do it functionally. We integrate [this clinic] into our weekly tumor boards that we started. With this, we now have robust tumor boards [informing] how we make recommendations to patients, how we get those patients into the appropriate clinical trials, and where surgery [might have a role].

Our whole world has changed regarding the neurosurgeon’s role [in brain cancer management]. Where surgery falls in [a treatment strategy] can be a critical step, sometimes even in metastatic cancer. Traditionally, neurosurgeons are the first people who make [surgical] decisions, because before [treatments] can [be effective against] systemic disease, we have to treat their brain or spinal tumors with surgery. Being integrated [in one clinic] lets us have quicker throughput, so patients can receive what they need—chemotherapeutic or radiation treatment—quicker once we get past the surgical part. Having a neurosurgeon lead that team, like I do, gives a big advantage.

What are the current limitations or unmet needs in the brain cancer surgical setting?

Hospital financing is becoming more difficult. We have a lot of administrators, and administrators are great, but we have to do a lot of selling of our ideas to find monies that don’t exist, to try to integrate novel therapeutics. That is a challenge that’s coming up with the National Institutes of Health now [that there is] decreased funding.

We’re struggling to translate our ideas into possible solutions in the clinic. [We should] work closely with our partners in industry, as well as leadership on the non-clinical side and the administrative side, to understand what we need to do and have a close relationship where we’re a team. At Rutgers, we’re fortunate to have that team environment so we can move these [treatments] through quickly, but we need to work with alternative ways of funding some of these initiatives through development.

Unfortunately, we have to reach out to patients and families to get some of these funds. That’s how our new Morris Cancer Center came through, because the Jack and Sheryl Morris family donated to that. Other people have certainly donated to that, but they started it. The Melchiorre Cancer Center in Livingston, New Jersey, our other standalone cancer center, came about through Our challenges [may be alleviated] through grateful giving and people understanding what we’re doing and that when we have these relationships, some of these barriers we’re finding can be alleviated.

What is the importance of raising awareness about brain cancer diagnosis and management, both for patients and physicians?

[There are] general concerns among the lay public about brain cancer being the end of life for patients once they get this diagnosis. The reality is that, as chief, I see a lot of incidental findings. A patient sneezes wrong, gets an MRI, and everyone thinks they have brain cancer.

Even when patients have brain cancer, we have long-term survivors. Awareness is important, because patients need to understand that when they get a diagnosis of a brain tumor, that doesn’t [necessarily] mean their life is over. It might mean they don’t even need surgery. It might mean they don’t need any treatment, or it might mean they need all those interventions.

References

1. Human Connectome Project (HCP). National Institute of Mental Health. Reviewed November 2022. Accessed January 20, 2026. https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/human-connectome-project-hcp
2. Yarlagadda S, Belnap S, Candela J, et al. Correlation between neurocognitive outcomes and neuroaxonal connectome alterations after whole brain radiotherapy: a proof-of-concept study. Cancers (Basel). 2025;17(11):1752. doi:10.3390/cancers17111752