Integrated model helps enhance patient care for pediatric brain tumors

The Brain Tumor Center at Children's Hospital Los Angeles is one of the largest and most comprehensive pediatric brain tumor programs in the country, integrating experts from multiple specialty areas into a coordinated treatment team.

That team includes pediatric specialists in neurosurgery, neuro-oncology, neurology, neuropathology, radiation oncology, neuroradiology, neuro-endocrinology and rehabilitation, as well as experts from the Center for Personalized Medicine, who provide advanced molecular, genetic and next-generation sequencing-based tumor testing and analysis.

Caring for these complex patients requires numerous disciplines across the hospital, and we have leading experts in each of these fields. The Center brings all of us together as a group to enhance patient care and take a team approach to decision-making."

Ashley Margol, MD, MS, Director of the Brain Tumor Center and Director of the Neuro-Oncology Program at Children's Hospital Los Angeles

Those team decisions are key to ensuring the best possible outcomes for children with brain tumors.

"It allows for the development of a plan for the best treatment modalities-;when to do surgery, what type of surgery, what type of chemotherapy," says Mark Krieger, MD, Surgeon-in-Chief at CHLA and Surgical Director of the Brain Tumor Center. "We make those decisions as a team, with the patient and family at the center.

"And it's not just at diagnosis," adds Dr. Krieger, the Billy and Audrey L. Wilder Chair in Neurosurgery. "Every step of the way, the entire team is involved in treatment decisions for the child."

The Center-;which sees 150 new patients each year-;also incorporates collaborative clinic appointments. Under this model, neurosurgeons and neuro-oncologists meet with patients and families side by side, in the same exam room, to discuss results of imaging studies, answer questions and jointly decide on a treatment plan.

"Families appreciate only having to make one appointment and being able to see multiple specialists in one clinic," says Susan Durham, MD, MS, Chief of the Division of Neurosurgery, Co-Director of the Neurological Institute and the J. Gordon McComb Family Chair in Neurosurgery. "At the same time, they're able to participate in their care in a more interactive way and be part of real-time discussions between different specialists."

That integrated model helps address each patient holistically. For example, a neuro-endocrinologist sees patients alongside a neuro-oncologist. That unique format has led to the team diagnosing endocrine effects from cancer treatment much earlier than under traditional referral models.

Children's Hospital Los Angeles is also home to one of the nation's largest clinical trial portfolios for children with brain and spinal cord tumors-;with 22 open studies and trials at this time.

Those trials offer access to innovative treatments that are often not available elsewhere in the region. For example, CHLA specialists are co-leading studies to use immunotherapy to treat brain tumors and are testing new ways to personalize treatment based on a tumor's genetics.

The Center is also a member of seven leading national and international clinical trial networks, which further expand access to clinical trials and new treatment options.

"We are continuing to build on our commitment to research and to expanding our basic and translational science as well," Dr. Margol says. "That is another benefit of our integrated team. We can come together to plan for the future and develop novel therapies for children and adolescents with brain tumors."