It’s still dark out as physicians gather for one of the most important meetings of the week: to go over, one by one, cases of children and teens with brain and spinal cord tumors.
About 20 specialists — representing neuro-oncology, neurosurgery, neurology, radiation oncology, neuroradiology, neuropathology, research and other areas — meet Thursday mornings to develop or adjust each child’s treatment plan.
The meeting, called the Pediatric Brain Tumor Board, ensures that each patient benefits from the full expertise and collaboration of physicians and other health care professionals at OHSU Doernbecher Children’s Hospital and beyond.
No other Oregon hospital offers this level of advanced care for children.
“We are working together for every single patient to make sure that we are bringing that patient the best possible outcome,” says Kellie Nazemi, M.D., the medical director of Doernbecher’s brain tumor program who started the board 10 years ago.
How it works
At a recent meeting, doctors start filing into a conference room on the 10th floor of OHSU Hospital about 6:45 a.m. Some grab a muffin or coffee from a back counter before quietly taking a seat in one of three narrow rows.
This day’s patients range in age from 5 to 17. Most are boys. They reflect the fiendish complexity of brain and spinal cord tumors. One boy has a spinal tumor causing so little trouble he may need only monitoring for now. Another has had multiple surgeries for a tenacious brain tumor.
Nazemi begins the discussion, going over concerns for each patient as neuroradiologist Jim Anderson, M.D., displays MRI scans of the patient’s brain or spine on two large screens. If a biopsy or tumor removal has been done, a neuropathologist shows slides of the cells under a microscope, indicating the tumor’s type and how aggressive it might be.
The doctors talk about next steps, taking advantage of one another’s expertise and discussing the family’s concerns. They work together to manage side effects of tumor treatment. An international expert on next-generation research, Yoon-Jae Cho, M.D., helps ensure that every option is considered.
Tumor boards aren't uncommon at major hospitals, but Doernbecher's has developed to include an unusually high level of intellectual firepower and commitment to collaboration.
Leaving egos at the door
Nazemi and Rebecca Loret de Mola, D.O., another pediatric oncologist, specialize in caring for children with brain and spinal cord tumors. Cho is on the front lines of global efforts to find new ways to fight pediatric brain tumors. The board also includes Lissa Baird, M.D., one of the nation’s top pediatric neurosurgeons.
The real beauty of Doernbecher’s board, Nazemi says, is that it’s big enough to have top-notch doctors but small enough that doctors leave their egos at the door to fully focus on the best care for each child. When needed, they consult colleagues at other top children’s hospitals.
“There are some scenarios where there simply isn’t a right answer, and in those cases, it’s nice to be able to reach out to our colleagues and ask their opinion about what they might do,” Nazemi says. “Our Doernbecher patients are able to benefit from the knowledge that’s all over the country and all over the world.”
A life saved
Nazemi tells of a recent case in which the board helped save the life of a 2-year-old. The boy had a type of brain tumor that’s highly survivable if neurosurgeons remove every trace.
A neuroradiologist on the board who knows the tumor can creep into a bony crevice pored over scans to make sure surgery was successful. He found a sliver that still needed to come out.
“That patient,” Nazemi says, “is doing really well now.”
The weekly Pediatric Brain Tumor Board brings together about 20 specialists in brain and spinal cord tumors, including in neurosurgery, oncology, neurology, radiation therapy, neuroradiology, neuropathology, research and other areas.
The board ensures that every child’s case is looked at repeatedly and from multiple angles.
World-class expertise in international research ensures that every option can be considered.