ESPE Abstracts

Introduction: Central nervous system tumours are the second most commonly encountered malignancy in children with 35 cases/million/year (1). However, only 10% affect the suprasellar/intrasellar region, which limits experience of such cases in any one centre. Multidisciplinary team meetings (MDT) are a well-recognised approach to obtain expertise beyond a single clinical site. Such meetings are often used to support diagnosis, investigation and management resulting in improved outcomes.

Aims and Objectives: We aimed to describe the landscape of the UK national hypothalamic-pituitary axis tumour (HPAT) MDT which has been in existence since 2010, examining its framework, the benefits it has brought to patient management (under 4 key domains), and how it has evolved over time.

Methodology: A mixed-methods descriptive approach was adopted to describe this unique clinical MDT which provides a national case-based approach in the care of HPAT cases. A retrospective review of meeting minutes was undertaken using electronic health records kept on a secure server at Great Ormond Street Children’s Hospital from 2011-2023, focusing on the four key domains for a successful MDT - team, infrastructure, meeting logistics and patient-centred decision making.

Results: We describe the creation of this enhanced paediatric HPAT MDT in 2010 between centres initially covering England. A series of monthly MDTs were subsequently organised commencing June 2011 with a view to initially discuss craniopharyngiomas and subsequently other rare midline tumours. This HPAT advisory group MDT has evolved over the subsequent 13 years providing expert advice for a multitude of cases. Overall, 137 meetings have taken place over the last 13 years with 498 cases discussed. Of these, the ratio of new: old cases discussed at these meetings was approximately 3:1 (363 new:135 old). The most commonly encountered lesions were craniopharyngiomas (n = 99), followed by prolactinomas (n = 67) and other forms of pituitary adenomas (n = 76). We are currently looking at the frequency in which our MDT has made changes in terms of management and MRI surveillance. Over time, this group has gained national and international recognition and cases are now often brought from outside the UK to be discussed.

Conclusion: This mixed-methods study describes the creation and evolution of a collaborative HPAT MDT which now covers the whole of the UK and often provides international advice as well over the course of 13 years. Given its international reach, issues such as capacity have arisen and decisions need to be made about the scope of advice it provides.