The Importance of Multidisciplinary Tumor Boards in Brain Metastases Care

Coordinating care for patients with brain metastases typically requires input from multiple specialties, including neurosurgery, neuroradiology, radiation oncology, and medical oncology, yet integrating that input consistently into treatment decisions remains a practical challenge across institutions.

In an interview with CancerNetwork® at the 2026 SNO ASCO CNS Metastases Conference in Boston, MA, Lizza Hendriks, MD, PhD, discussed why she believes every patient with central nervous system (CNS) metastases deserves a dedicated multidisciplinary team (MDT) discussion. Hendriks described data suggesting that treatment proposals change in a significant percentage of patients once discussed in an MDT setting, along with signals, though based on biased data, that survival may improve for these patients. She characterized MDT discussion as a comparatively simple and low-cost way to improve care.

When asked about where gaps persist between specialties in this collaborative model, Hendriks pointed to bidirectional knowledge gaps: radiation oncologists are not always familiar with the intracranial efficacy of systemic therapies, while those prescribing systemic therapy do not always understand the effects of specific radiotherapy techniques or when it is safe to omit radiotherapy altogether. She also noted that neurosurgery is often underutilized as a resource, a pattern she has observed in the Netherlands specifically. To address these gaps outside of live MDT discussions, Hendriks described a regional initiative in her own practice to document formal care pathways covering the effects of systemic therapy, contraindications for radiotherapy, and indications for surgery.

Hendriks is a professor of thoracic oncology at Maastricht University Medical Center+ in the Netherlands, where she leads the clinical lung cancer research department and chairs the Innovative Cancer Diagnostics Therapy group at the GROW School for Oncology and Developmental Biology at Maastricht University. Her research focuses on brain metastases in patients with lung cancer.

Transcript:

CancerNetwork: What is the importance of integrated multidisciplinary care when treating someone with brain metastases?

Hendriks: It’s very important. For me, all patients with CNS metastases deserve a dedicated multidisciplinary team [MDT] discussion with a neurosurgeon, a neuroradiologist, a radiation oncologist, someone who knows about systemic therapy efficacy in the brain, preferably also nurses, et cetera, with input from the patient. There are indeed some data that when patients are discussed in an MDT, in a significant percentage of these patients, the treatment proposal changes. They are biased data, but there are also hints that survival improves for these patients. These patients deserve an MDT discussion, and it’s a quite easy and cheap way to improve care for our patients.

Ae there any places where you see gaps, universally, between radiation oncologists and medical oncologists in that multidisciplinary care?

I think we still need to educate each other. Radiation oncologists don’t always know about the intracranial efficacy of our drugs. On the other hand, as people prescribing systemic therapy, we don’t always know the effects of specific radiotherapy techniques and whether it’s safe or not to omit radiotherapy. Also, for neurosurgery, at least in the Netherlands, we quite often overlook neurosurgeons. There is a bigger place for neurosurgery [in care]. We really need to educate each other.

What we did in our institution, in our region, is have care pathways written down, as well as [determine] what’s the effect of systemic therapy, contraindications for radiotherapy, and indications for surgery. That way, even when you cannot attend the MDT, or if you need to make an emergency decision, at least you have the care pathway to fall back on [and] to have some evidence-based guidance.