Multidisciplinary Coordination in DMG Management

Funding support provided by Chimerix/Jazz Pharmaceuticals. Content independently developed and published by OncLive.

Once a diffuse midline glioma with an H3K27M mutation is confirmed, the priority is timely initiation of treatment. Radiotherapy remains the frontline standard of care, and patients are typically referred to both radiation oncology and neuro-oncology as soon as possible. Unlike glioblastoma, where treatment may be delayed several weeks post-surgery to allow for wound healing, many patients with midline gliomas undergo only a biopsy, which allows earlier treatment initiation. However, delays can still occur due to logistical issues such as back-and-forth pathology reviews between community and tertiary centers or the need to stabilize patients with neurological deficits through rehabilitation before beginning therapy. Balancing rapid treatment with optimization of functional status is an important multidisciplinary challenge.

Coordination of care is essential to streamline this process. Initially, neurosurgery plays a central role in guiding the patient through diagnosis, but once treatment begins, neuro-oncology typically becomes the lead discipline, serving as the “quarterback” of the team. Radiation oncologists, neurosurgeons, and neuro-oncologists must work closely together to determine the best approach, especially when imaging reveals features that could compromise treatment. In some cases, neurosurgeons are asked to consider resection or other interventions to prevent complications during radiation, such as cyst growth, swelling, or obstruction of cerebrospinal fluid flow. Proactive evaluation of these risks ensures patients are stabilized before entering radiation therapy.

For unresectable tumors, communication between surgical teams, neuro-oncology, and radiation oncology is crucial to prevent patients from being lost in transition. Surgeons often directly notify neuro-oncologists and radiation oncologists about high-risk findings and emphasize the need to begin therapy without unnecessary delays. Even wound closure is performed with radiation timelines in mind, using techniques that support earlier treatment starts. This level of coordination underscores the importance of a multidisciplinary approach, ensuring patients receive timely, seamless care tailored to the aggressive nature of diffuse midline gliomas.