Current landscape and challenges of neuro-oncological molecular tumor boards in Germany: results of a nationwide follow-up survey

In 2022, a nationwide survey revealed heterogeneity and limited standardization in the implementation of molecular tumor boards (MTBs) for neuro-oncology in Germany. This follow-up study aimed to assess recent developments, structural changes, and the integration of digital tools. An anonymous online questionnaire was distributed to approximately 445 members of the German Neuro-Oncology Working Group (NOA). Items focused on MTB availability, frequency, tumor inclusion, recommendation pathways, implementation, digital infrastructure, and perceived barriers. 35 responses were collected. Respondents were primarily experienced neurosurgeons and neurologists working in certified university centers. Most were based in Bavaria, Baden-Württemberg, North Rhine–Westphalia, and Berlin. The number of in-house MTBs increased, with most boards meeting weekly. A broader range of tumor entities—including lower-grade gliomas—and earlier therapy lines are increasingly discussed. Recommendations were issued in fewer than half of cases, and over 30% of proposed therapies were implemented, though often hindered by lack of reimbursement. Virtual tumor boards (50%) and structured databases (40%) are increasingly used, and around 5% of patients are enrolled into national studies. Follow-up strategies and feedback loops remain inconsistent across centers. MTBs have become more established in neuro-oncology care, reflecting a growing commitment to precision medicine. However, implementation of recommendations remains limited, often constrained by lack of actionable targets, challenges accessing studies or off-label treatments. To fully realize the potential of MTBs, standardized integration pathways, greater harmonization, broader study offerings, and structured evaluation systems are needed.