The Multidisciplinary Tumor Board (MTB) is a multidisciplinary meeting that was born to maximize the customization of the clinical path of patients through the interaction of multiple hospital professionals, in response to increased possibilities in therapeutic and surgical management [1,2,3,4]. This approach has a significant impact both on the clinical management of the patient with a better therapeutic chance of response and on the educational activity: in fact, apart from participant physicians, also medical students, and house staff, if part of the institution, are a welcome addition to the meetings and enhance the educational qualities of the board [1, 6].

It is important to note, however, that our review of the literature, which focuses on the multidisciplinary approach to pediatric neuro-oncology patients, indicates limited literature on this topic. Nonetheless, all articles concur that a multidisciplinary approach has a significant impact on the therapeutic management of patients in both in high-income and developing countries. It has been observed that in high-income countries, the multidisciplinary approach is now integral to clinical practice in most hospital facilities.

For instance, in the United States Abdel-Baki MS et al. reported clinics treating pediatric brain tumors use a multidisciplinary approach to diagnosis and treatment, yielding excellent patient outcomes in early diagnosis, treatment, and patient/parent satisfaction (…). However, while evidence-based data on the benefits of multidisciplinary teams on patient outcomes is limited, it has to considered that satisfaction extends beyond early diagnosis and treatment to encompass parental knowledge of this approach [3].

Our center, thanks to a multidisciplinary approach to pediatric neuro-oncology patients, aligns with these positive outcomes, similar to other centers in high-income countries, such as Germany [16].

In particular, our center also communicates to all parents of pediatric neuro-oncology patients what emerges from multidisciplinary meetings and makes them participate in relation to the resulting multidisciplinary approach.

However, our experience differs from centers in low-middle income countries. In developing countries, late diagnosis and high treatment costs result in a high dropout rate among cancer patients. Nevertheless, in few areas where hospitals can ensure a multidisciplinary approach, improved patient management is observed, leading to better therapeutic outcomes, reduced treatment abandonment, and decreased patient loss to follow-up [17].

An important asset to tumor boards is the use of online platforms, facilitating the organization of tumor boards in hybrid mode. This approach to multidisciplinary meetings is beneficial in both low- and high-income countries. In low- and middle-income countries, such an approach (which may also include consultations with specialists from other countries) enables physicians to access real-time, high-level subspecialist expertise, providing a valuable platform for worldwide information exchange [18].

In high-income countries, including our center, online platforms for tumor boards were adopted as a solution during the COVID-19 pandemic. To date, our pnMTB continues to operate in a hybrid mode.

Our sessions involve the participation of neurosurgeons, neuropathologists, oncologists, radiotherapists, and two pediatric neuroradiologists, each with a decade of experience. Notably, pediatric neuroradiologists often engage in double readings, especially for difficult cases. Our analysis showed that 236 cases were discussed, corresponding to 107 patients; compared to adult MTB [2], a greater number of patients were discussed more than once (49%), due to a better prognosis of several pediatric brain cancers than those of adults [3, 4, 19, 20]. Notably, the average number of discussions per individual patient has been 2.2 times, with certain patients undergoing as many as 6–7 discussions. The frequencies of the histotypes discussed at our pnMTB are partially indicative of their prevalence in the general population. Notably, the histotypes most often brought into discussion include both low-grade and high-grade gliomas [19, 21].

A significant majority (95%) of the 236 pediatric MRI examinations were conducted within our institution. This high percentage is a result of the specialized requirements of pediatric MRI, frequently necessitate anesthesia —a service exclusively available in a few diagnostic centers, including ours. Consequently, the limited use of anesthesia in other hospitals contributes to a low number of reassessments, totaling 11 exams. This trend differs from the literature on adult patients, suggesting unique considerations for pediatric cases, particularly in the context of anesthesia requirements [2].

Regarding these 11 reassessments, it is noteworthy that there was a change in patient treatment (CPT) for all cases, either due to different diagnoses (7/11) or follow-up assessments (4/11) by the pnMTB neuroradiologist. Several authors have demonstrated the critical role of expert radiologist reviews in multidisciplinary team settings and their impact on patient management [2]. Our high figure is likely attributable to the fact that many exams were performed at other locations where the number of radiologists with expertise in neuro-oncology, especially pediatric neuro-oncology, is low. Additionally, external radiologists often lack the support of integrated clinical and therapeutic data. A practical example: a two-year-old girl who, following a seizure in a febrile episode, performs an MRI at another center documenting the presence of an area of altered signal in the periventricular deep white substance adjacent to the left frontal horn, hyperintense in FLAIR, without contrast enhancement, in which the suspicion of inflammatory injury was placed. The case was subsequently submitted to the pnMTB by our neurosurgeons with a request for characterization of the lesion, directed to neuroradiologists. The initial case review raised suspicion of glial infiltrative lesion without features of biological aggression. The pnMTB’s final decision was in favor of surgery intervention. During the subsequent MTB meeting, the case was re-discussed, and histological examination confirmed the suspicion of neuroradiologists, documenting it as a diffuse astrocytic glial neoplasm.

In our department, MRI reporting of the pediatric central nervous system cases is performed by a team of neuroradiologists. Therefore, it is rare that the pre-pnMTB diagnosis is changed by the neuroradiologist during the pnMTB. However, assessing tumor response to treatment in pediatric neuro-oncology remains highly challenging, especially with the advent of new therapies (such as antiangiogenic agents) and the necessity to use Response Assessment in Pediatric Neuro-Oncology (RAPNO) criteria. This expertise is held by pediatric neuroradiologists, who are too few to assess all pediatric MRIs. Consequently, the impact of pediatric neuroradiologists during pnMTB is mainly related to CPT, where it was decisive in 72 of the 115 cases in which there was a change in therapeutic management (especially in the case of ependymomas 75%) this figure is not to be related to an initial misdiagnosis but rather to modification in tumor response assessments.

As reported by several authors also in our study it was observed that cases are more frequently presented by oncologists (88.3%) and to a lesser extent neurosurgeons (13.9%) with questions targeted at the disease status (76%) and radiological diagnosis (11%); these questions are mainly addressed to neuroradiologists (70%).

Data analysis showed that the most frequently shared pnMTB decisions were follow-up (47%) and chemotherapy treatment (34%), while less frequently surgical treatment (7%); it has also been observed that based on similar diagnostic questions similar clinical-therapeutic paths have been undertaken, thus denoting a substantial decision homogeneity of pnMTB.

Our study showed that the time devoted to the discussion of the individual case during pnMTB is 9–12 min and this data is not affected by the clinical question or by the tumor subtype.

However, it should be considered how the neuroradiologist, in the preparation of each patient before the pnMTB, must re-evaluate every single examination of the patient integrating the clinical-anamnestic data and sometimes re-elaboration of diffusion and/or perfusion sequences.

Based on the findings of the Snyder et al. study [22], the preparation of a case takes on average 9 min, and with an average number of 7 cases, it can be estimated that the preparatory effort for each neuroradiologist is about 60 min with an additional of 60 to 80 min per pnMTB session. The pediatric neuroradiologist has a central role in pnMTB since he must re-evaluate the examinations of all patients, regardless of the clinical question posed, in a large percentage of cases resulting in a change in CPT. It is therefore necessary that the figure of the dedicated neuroradiologist is an expert with a wide knowledge of the therapies used and the modifications that these determine on the MRI findings, knowing how to use advanced imaging techniques necessary for the differential diagnosis between progression and post-treatment modifications to be able to correctly determine the disease status and consequently to direct the best therapeutic path for the patient. In supplementary materials, Table 5 summarizes and compares the multidisciplinary approach between different countries [23,24,25].

This study has several limitations. First, our study conducted retrospectively at a single tertiary care academic medical center, may not offer a representative sample of cases for generalization to other nMTBs. Secondly, the absence of comprehensive clinical information about patient outcomes makes it difficult to establish a clear association between MTB discussions and improved prognosis for the patients discussed.