Objectives
  • To be able to perform specialist assessment, initial management of symptoms, diagnostic workup, treatment and counselling of patients with the most common primary malignant brain tumours and brain metastases

Awareness
  • Awareness of the WHO classification of brain tumours, including key molecular diagnostic definitions

  • Awareness of the appropriate usage of diagnostic modalities

  • Awareness of key prognostic factors for most common tumours

  • Appreciation of the role of surgery, radiation therapy, other local modalities and systemic therapies for the treatment of primary brain tumours

  • Awareness of the appropriate symptomatic and supportive care interventions, including the engagement of additional staff as appropriate, including physiatrists, social workers, home health nurses, palliative care and hospice staff

Knowledge
  • Familiarity with the capabilities and limitations of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of primary and metastatic brain tumours, especially the phenomena of pseudoprogression and pseudoregression

  • Familiarity with the prognostic implications of tumour grade and molecular markers, especially 1p/19q codeletion, isocitrate dehydrogenase (IDH) mutations and 06-methylguanine-DNA methyltransferase (MGMT) promotor methylation, and their potential impact on the management of patients with primary brain tumours

  • Familiarity with the implications of the different pathological and molecular subtypes of gliomas for the selection of appropriate treatment strategies

  • Knowledge of the appropriate use of surgery, radiation therapy, chemotherapy, antiangiogenic therapy and tumour-treating fields for patients with newly diagnosed and recurrent gliomas, and tumours metastatic to brain

  • Knowledge of the management of tumours metastatic to brain and central nervous system

  • Knowledge of potential complications of all therapeutic modalities in the treatment of primary and metastatic brain tumours and the management of those complications

  • Familiarity with the management of increased intracranial pressure, seizures, fatigue and cognitive impairment

Skills
  • Ability to obtain a relevant clinical history and general and neurological examination for patients with primary and metastatic brain tumours

  • Ability to interpret fundamental elements on CT and MR images

  • Ability to draw pertinent conclusions from pathology reports

  • Ability to present relevant components of history, physical examination, imaging and pathology results—indications for additional molecular characterisation, as appropriate

  • Ability to contribute to ongoing assessments of patients with primary and metastatic brain tumours

  • Ability to develop and oversee treatment plans for chemotherapy, antiangiogenic therapy and other systemic therapies for patients with primary and metastatic brain tumours

  • Ability to work effectively with a multidisciplinary and multimodality treatment team, including neurosurgeons, neurologists, radiation oncologists, neuropsychologists and physiatrists to develop multimodality treatment plans

  • Ability to request appropriate referrals to neurosurgeons, radiation oncologists and other specialists as appropriate

  • Ability to manage toxicities emerging from all treatment modalities

  • Ability to manage symptoms related to the primary and metastatic brain tumours, including increased intracranial pressure, seizures, deep venous thromboses and pulmonary emboli