# Collaborative Frontiers in Pediatric Neuro-Oncology: Establishing an International Tumor Board for Enhanced Care and Global Impact

## TL;DR

An international tumor board was created to improve care for children with brain tumors, especially in low- and middle-income countries, by sharing expertise and resources.

## Contribution

This is the largest international pediatric neuro-oncology tumor board, demonstrating telemedicine's potential to bridge global healthcare disparities.

## Key findings

- 101 pediatric CNS tumor cases were reviewed over three years, with 60.7% of recommendations focused on therapeutic strategies.
- Advanced diagnostics like methylation profiling improved diagnostic accuracy in several cases.
- Participants reported high satisfaction, with 91% finding the meetings educational despite challenges like time constraints.

## Abstract

Central nervous system tumors are the leading cause of cancer-related mortality in children, with significant disparities in diagnostic and treatment capabilities between low- and middle-income countries and high-income countries. This study outlines the establishment of an international neuro-oncology tumor board to address these gaps.

The tumor board was initiated in January 2021 through a partnership between Washington University in St. Louis, USA, and nine institutions, ultimately expanding to 39 institutions across 25 countries. Monthly virtual meetings facilitated multidisciplinary case reviews offering diagnostic and management recommendations. A retrospective analysis of 29 sessions over three years was conducted, and a cross-sectional web-based survey among participants assessed their experiences and satisfaction.

From January 2021 to December 2023, 101 cases were reviewed. The most diagnoses were low-grade gliomas (23.4%) and neurofibromatosis type 1 and 2 (32.7%). Newly diagnosed cases comprised 51%, while 40% involved recurrent or progressive disease, and 9% were inquiries during ongoing therapy. Recommendations predominantly addressed therapeutic strategies (60.7%). Advanced diagnostics, such as methylation profiling, refined diagnoses in several cases. The survey, with a 35% response rate, showed high satisfaction, with 91% finding the meetings educational. Barriers included time constraints (71%) and conflicting commitments (27%).

This initiative, to our knowledge, represents the largest international pediatric neuro-oncology tumor board. Multidisciplinary discussions improved diagnostic precision, informed therapeutic decision-making and facilitated educational exchange. Participants reported positive impacts on professional development and alignment with institutional needs. Despite challenges, this study highlights telemedicine’s potential to bridge resource disparities and improve the outcomes globally.