Interdisciplinary Tumor Board Research Articles

Interdisciplinary Comprehensive Breast Tumor Boards: Their Role in the Comprehensive Management of Contemporary Breast Cancer

The presentation of invasive breast cancer is improving dramatically with widespread mammographic screening. Paradoxically, the management of breast cancer is becoming more complex because of the varieties of diagnostic and therapeutic options available. With complex disease management, the best system for incorporating multiple specialists' opinions is the multidisciplinary breast tumor board. Important features of this integrated approach are prospective presentation of patients, projection of mammograms, films, pathology slides, and prognostic algorithms, such as http://www.adjuvantonline.com , or a more sophisticated new algorithm: http://www.cancer-math.net . With these adjuncts to case presentation, comprehensive discussion can occur for appropriate options for the individual patient.

Positron Emission Tomography for Staging of Pediatric Sarcoma Patients: Results of a Prospective Multicenter Trial

The objective of this study was to evaluate the impact of positron emission tomography (PET) using fluorine-18-fluorodeoxyglucose (FDG) for initial staging and therapy planning in pediatric sarcoma patients. In this prospective multicenter study, 46 pediatric patients (females, n = 22; males, n = 24; age range, 1 to 18 years) with histologically proven sarcoma (Ewing sarcoma family tumors, n = 23; osteosarcoma, n = 11; rhabdomyosarcoma, n = 12) were examined with conventional imaging modalities (CIMs), including ultrasound, computed tomography (CT), magnetic resonance imaging, and bone scintigraphy according to the standardized algorithms of the international therapy optimization trials, and whole-body FDG-PET. A lesion- and patient-based analysis of PET alone and CIMs alone and a side-by-side (SBS) analysis of FDG-PET and CIMs were performed. The standard of reference consisted of all imaging material, follow-up data (mean follow-up time, 24 +/- 12 months), and histopathology and was determined by an interdisciplinary tumor board. FDG-PET and CIMs were equally effective in the detection of primary tumors (accuracy, 100%). PET was superior to CIMs concerning the correct detection of lymph node involvement (sensitivity, 95% v 25%, respectively) and bone manifestations (sensitivity, 90% v 57%, respectively), whereas CT was more reliable than FDG-PET in depicting lung metastases (sensitivity, 100% v 25%, respectively). The patient-based analysis revealed the best results for SBS, with 91% correct therapy decisions. This was significantly superior to CIMs (59%; P < .001). In staging pediatric sarcoma, subsidiary FDG-PET scanning depicts important additional information and has a relevant impact on therapy planning when analyzed side-by-side with CIMs.

The interdisciplinary tumour board as an essential tool for quality management in care of cancer patients in a community hospital

The interdisciplinary tumour board as an essential tool for quality management in care of cancer patients in a community hospital

The Brain Tumor Board: Lessons to Be Learned from an Interdisciplinary Conference

Background: The aim of this study is to analyze the work ofthe interdisciplinary Brain Tumor Board (BTB) which was establishedat Freiburg University Hospital in 1998. Patientsand Methods: From January 1998 to December 2003, a totalof 1,516 patients were discussed in 259 meetings of the BTB.The protocols of the BTB were analyzed retrospectively. Results:In 79% of the patients, the diagnosis was based onhistological findings or a typical radiological appearance ofa lesion, or both. This group was composed of 4 subgroups:28% benign skull base tumors (19% meningiomas, 4% pituitaryadenomas, 3% acoustic schwannomas, 2% others),24% primary brain tumors of glial origin (8% glioblastomas,12% gliomas other than glioblastomas, 5% oligoastrocytomasor oligodendrogliomas), 19% brain metastases, and8% other brain or skull base tumors. In 13% of the cases, theexact diagnosis was still unknown when the patient waspresented. 8% of the presentations were motivated by nontumorousinterdisciplinary problems (e.g. arterio-venousmalformations). The recommendations given by the BTB included:23% further diagnostic procedures (11% non-invasiveexaminations, 12% stereotactic biopsies), 57% activeantitumoral therapy (22% resection, 17% fractionated radiotherapy,13% radiosurgery, 5% chemotherapy, <1% embolization),20% no treatment (14% watchful waiting, 6%supportive care). 91% of the BTB recommendations were realizedwithin 3 months. Conclusion: Interdisciplinary careseems to be particularly necessary in patients with benignskull base tumors, gliomas and brain metastases. Decisionsmade in a small interdisciplinary group of experts have ahigh potential of subsequently being realized.

Reconstructive plastic surgery in soft tissue sarcomas of the extremities

Limb-sparing resection in combination with radio/chemotherapy is recommended in cases of soft tissue sarcomas of the extremities. Plastic surgery techniques and clinical results in 69 patients with 71 malignant soft tissue tumors who had hadergone resection, as well as additional reconstructive procedures for functional improvement, are discussed. The integration of patients suffering from soft tissue sarcomas of the extremities into the treatment protocols of interdisciplinary tumor boards is recommended. Plastic surgery salvage procedures (including microsurgical free-tissue transfer) are discussed in detail. If the patient is judged unsuitable for these procedures or if distalization is not possible, amputation is the final option.