Abstract Background Central nervous system (CNS) tumors are the leading cause of pediatric cancer-related mortality. Significant disparities in diagnostic and therapeutic infrastructure persist between low- and middle-income (LMICs) and high-income countries (HICs). Twinning initiatives and global health partnerships serve as effective frameworks for exchanging specialized expertise. This study evaluates an international pediatric neuro-oncology tumor board (iPNOTB) established to mitigate these global inequities. Methods In January 2021, a monthly multidisciplinary iPNOTB was inaugurated via a secure teleconferencing platform. Initially a partnership between Washington University in St. Louis and nine sites, the initiative expanded to 70 institutions across 40 countries in Asia, Africa, Europe, Oceania, and the Americas. We retrospectively analyzed 57 sessions conducted over five years. Since February 2024 a collaboration with the molecular tumor board of the Molecular Neuro-pathology Outreach Consortium has been implemented, incorporating cases requiring DNA methylation or technical consultation. Results From January 2021 to January 2026, 201 complex cases were reviewed. Over 2,500 specialists participated, including pediatric neuro-oncologists, neurologists, neurosurgeons, neuroradiologists, and neuropathologists. Multidisciplinary panels provided consensus-based management recommendations for each case. A dedicated quarterly neurofibromatosis board reviewed 41 cases across 13 additional sessions. The primary indications for case presentation were optimization of therapeutic management, diagnostic discrepancies, and limitations in molecular diagnostic infrastructure. Rare tumors and newly defined CNS entities were most frequently reviewed. Over 50% of cases were new diagnoses; the remainder involved recurrent/progressive disease or therapy adjustments. Recommendations focused primarily on therapeutic strategies, with advanced diagnostics, such as DNA methylation profiling, providing critical refinement for several diagnoses. Conclusion This initiative represents the largest international pediatric neuro-oncology tumor board reported to date. Regular multidisciplinary collaboration enhanced diagnostic precision and informed complex therapeutic decision-making. These findings underscore the transformative potential of telemedicine in bridging resource gaps and improving global outcomes for children with CNS tumors.
Baroni et al. (Tue,) studied this question.