A Multidisciplinary Central Nervous System Clinic Model for Radiation Oncology and Neurosurgery (Radians): Three-Year Experience with Brain and Skull Base Lesions in a Community Hospital Setting

Background: Outpatient collaboration between Radiation Oncology and Neurosurgery for central nervous system (CNS) disease via the RADIANS (RADIation oncology And NeuroSurgery) clinic has been previously reported. Although novel and early in its multidisciplinary clinic design, patients found the tandem visit with the radiation oncologist and neurosurgeon highly favorable. Investigators hypothesized the clinic model would optimize patient and physician time by reducing clinic visits, improve quality of care, deliver evidence-based treatment modalities, while providing access for on-going clinical trials. The present study reports on the 3-year experience with patients evaluated for brain and skull base CNS lesions in a community hospital setting.

Methods: Clinical and demographic data were prospectively collected and maintained in a secure database for patients seen in the RADIANS clinic. Patient surveys were administered (0–5 scale, 0 = not satisfied; 5 = very satisfied), and data were reviewed over 3 years. Descriptive statistics are reported as mean and percentages for patient characteristics, diagnosis, treatment, and outcomes.

Results: Sixty-seven patients were evaluated between August 2016 and August 2019 in RADIANS with histologic confirmation of CNS brain or skull base lesions. Mean age was 61.0 years. Females represented 58.2% (n = 39) and males 41.8% (n = 28) of patients. Mean distance traveled to RADIANS was 66.5 miles (median = 16.9; range = 0.6–340). The most common referral source was medical oncology (28.4%). Mean overall satisfaction score was 4.77 (n = 26 respondents). Forty-three patients had malignant CNS disease; 24 had benign disease. Of those with malignant CNS disease, 28 patients had metastatic brain disease and 6 had both metastatic brain and spine disease (lung = 19; breast = 5; other = 4). Nine had malignant primary brain lesions (glioblastoma = 7; astrocytoma = 2) and 24 had benign primary brain lesions (meningioma = 15; glioma = 2; cavernoma = 1; pineal cyst = 1; pituitary adenoma = 1; other = 4). Forty-three patients had at least one comorbidity of which chronic obstructive pulmonary disease (34.3%) and hypertension (28.4%) were the two most common. Thirty-six percent of patients had a BMI ≥30 kg/m² (n = 24). Thirty-eight patients had stage IV disease (deceased = 12; hospice = 6, and active treatment = 20). Fifty-two percent (35/67) of patients with brain and skull base CNS lesions received radiation therapy (RT)—the majority (69%, 24/35) of which was stereotactic radiosurgery/stereotactic body RT. Fifteen percent (10/67) received neurosurgical intervention only in the form of craniotomy with tumor resection. Twenty-five percent (17/67) had both RT and neurosurgery. One-third of patients with benign CNS disease received surgical intervention, the remaining two-thirds were observed and followed-up with repeat surveillance imaging.

Conclusion: The RADIANS multidisciplinary clinic is the first of its kind to be reported, and continues to be viewed favorably by patients at extended follow-up. These results demonstrate the RADIANS clinic model is suitable in a community setting and can serve as an adequate regional referral center for CNS brain and skull base disease. Patients with varying degrees of comorbidities, systemic disease status, and cancer staging were appropriately treated. Continued data collection and treatment analysis will be of priority for future investigation regarding cost-benefit, clinical long-term outcomes, and possible mechanisms for early detection by means of vigilant follow-up and imaging surveillance.