Top Line: What components of the different RANO criteria best correlate with survival outcomes for glioblastoma?
The Study: The Response Assessment in Neuro Oncology (RANO) criteria are commonly used in clinical trials to define progression for glioblastoma (GBM). The original RANO criteria were established in 2010. Pretreatment baseline T1+C and T2 FLAIR sequences are compared to posttreatment imaging to categorize the extent of response. In 2017, the modified RANO (mRANO) criteria made adjustments including the use of the post-radiation scan for baseline, the elimination of T2 FLAIR evaluation for defining progression, and the requirement for a confirmatory MRI within 12 weeks to define progression. Finally, immunotherapy RANO (iRANO) criteria have also been developed to allow for things like new lesions outside the treatment field that may sometimes occur with immunotherapy. This large study used over 1000 GBM cases (526 new GBM, 580 recurrent GBM) to compare how well progression defined by the different RANO criteria correlated with overall survival. Both RANO and mRANO showed strong correlations between PFS and OS for new GBMs and moderate correlations for recurrent GBMs. Neither showed superior performance nor did the addition of iRANO criteria in patients who received immunotherapy. When it came to the specific criteria for evaluating response, the authors found that the use of the post-radiation MRI as the baseline scan showed a trend to better correlation with OS compared to using the pretreatment scan as it better accounted for treatment-related changes. They also found that confirmatory scans improved performance, but only when used after potential progression in the first 12 weeks after treatment as this is the timeframe when pseudoprogression is more likely. Finally, the evaluation of T2 FLAIR changes in addition to enhancement did not improve the correlation in PFS and OS.
TBL: This study found that RANO, mRANO, and iRANO have about the same correlation with OS in patients with new and recurrent GBM. Post-radiation scans appear to perform the best as baseline scans, confirmatory scans can be useful in the first 12 weeks after treatment, and T2 FLAIR changes add little to response assessment. | Youssef, J Clin Oncol 2023
The Study: The Response Assessment in Neuro Oncology (RANO) criteria are commonly used in clinical trials to define progression for glioblastoma (GBM). The original RANO criteria were established in 2010. Pretreatment baseline T1+C and T2 FLAIR sequences are compared to posttreatment imaging to categorize the extent of response. In 2017, the modified RANO (mRANO) criteria made adjustments including the use of the post-radiation scan for baseline, the elimination of T2 FLAIR evaluation for defining progression, and the requirement for a confirmatory MRI within 12 weeks to define progression. Finally, immunotherapy RANO (iRANO) criteria have also been developed to allow for things like new lesions outside the treatment field that may sometimes occur with immunotherapy. This large study used over 1000 GBM cases (526 new GBM, 580 recurrent GBM) to compare how well progression defined by the different RANO criteria correlated with overall survival. Both RANO and mRANO showed strong correlations between PFS and OS for new GBMs and moderate correlations for recurrent GBMs. Neither showed superior performance nor did the addition of iRANO criteria in patients who received immunotherapy. When it came to the specific criteria for evaluating response, the authors found that the use of the post-radiation MRI as the baseline scan showed a trend to better correlation with OS compared to using the pretreatment scan as it better accounted for treatment-related changes. They also found that confirmatory scans improved performance, but only when used after potential progression in the first 12 weeks after treatment as this is the timeframe when pseudoprogression is more likely. Finally, the evaluation of T2 FLAIR changes in addition to enhancement did not improve the correlation in PFS and OS.
TBL: This study found that RANO, mRANO, and iRANO have about the same correlation with OS in patients with new and recurrent GBM. Post-radiation scans appear to perform the best as baseline scans, confirmatory scans can be useful in the first 12 weeks after treatment, and T2 FLAIR changes add little to response assessment. | Youssef, J Clin Oncol 2023