RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults

Author:

Wen Patrick Y.1ORCID,van den Bent Martin2ORCID,Youssef Gilbert1ORCID,Cloughesy Timothy F.3ORCID,Ellingson Benjamin M.4ORCID,Weller Michael5ORCID,Galanis Evanthia6,Barboriak Daniel P.7ORCID,de Groot John8ORCID,Gilbert Mark R.9,Huang Raymond10ORCID,Lassman Andrew B.11ORCID,Mehta Minesh12ORCID,Molinaro Annette M.13ORCID,Preusser Matthias14ORCID,Rahman Rifaquat15ORCID,Shankar Lalitha K.16,Stupp Roger17ORCID,Villanueva-Meyer Javier E.18ORCID,Wick Wolfgang19ORCID,Macdonald David R.20,Reardon David A.1ORCID,Vogelbaum Michael A.21ORCID,Chang Susan M.8

Affiliation:

1. Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA

2. Department Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands

3. UCLA Brain Tumor Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA

4. UCLA Brain Tumor Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA

5. Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland

6. Mayo Clinic, Department of Oncology, Rochester, MN

7. Department of Radiology, Duke University Medical Center, Durham, NC

8. Division of Neuro-Oncology, Department of Neurosurgery, University of California, San Francisco, CA

9. Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD

10. Division of Neuro-radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA

11. Division of Neuro-Oncology, Department of Neurology, Herbert Irving Comprehensive Cancer Center and Irving Institute for Clinical and Translational Research, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, NY

12. Miami Cancer Institute, Miami, FL

13. Division of Biomedical Statistics and Informatics, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA

14. Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria

15. Department of Radiation Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA

16. Clinical Trials Branch, Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD

17. Malnati Brain Tumor Institute, Lurie Comprehensive Cancer Center and Departments of Neurological Surgery, Neurology and Division of Hematology/Oncology, Northwestern University, Chicago, IL

18. Departments of Radiology and Neurosurgery, University of California San Francisco, San Francisco, CA

19. Department of Neurology Heidelberg University Hospital & Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany

20. Departments of Clinical Neurological Sciences and Oncology (Emeritus), Western University, London, Ontario, Canada

21. Departments of Neuro-Oncology and Neurosurgery, Moffitt Cancer Center, Tampa, FL

Abstract

PURPOSE The Response Assessment in Neuro-Oncology (RANO) criteria for high-grade gliomas (RANO-HGG) and low-grade gliomas (RANO-LGG) were developed to improve reliability of response assessment in glioma trials. Over time, some limitations of these criteria were identified, and challenges emerged regarding integrating features of the modified RANO (mRANO) or the immunotherapy RANO (iRANO) criteria. METHODS Informed by data from studies evaluating the different criteria, updates to the RANO criteria are proposed (RANO 2.0). RESULTS We recommend a standard set of criteria for both high- and low-grade gliomas, to be used for all trials regardless of the treatment modalities being evaluated. In the newly diagnosed setting, the postradiotherapy magnetic resonance imaging (MRI), rather than the postsurgical MRI, will be used as the baseline for comparison with subsequent scans. Since the incidence of pseudoprogression is high in the 12 weeks after radiotherapy, continuation of treatment and confirmation of progression during this period with a repeat MRI, or histopathologic evidence of unequivocal recurrent tumor, are required to define tumor progression. However, confirmation scans are not mandatory after this period nor for the evaluation of treatment for recurrent tumors. For treatments with a high likelihood of pseudoprogression, mandatory confirmation of progression with a repeat MRI is highly recommended. The primary measurement remains the maximum cross-sectional area of tumor (two-dimensional) but volumetric measurements are an option. For IDH wild-type glioblastoma, the nonenhancing disease will no longer be evaluated except when assessing response to antiangiogenic agents. In IDH-mutated tumors with a significant nonenhancing component, clinical trials may require evaluating both the enhancing and nonenhancing tumor components for response assessment. CONCLUSION The revised RANO 2.0 criteria refine response assessment in gliomas.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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