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Review
. 2017 Apr;14(2):307-320.
doi: 10.1007/s13311-016-0507-6.

Modified Criteria for Radiographic Response Assessment in Glioblastoma Clinical Trials

Benjamin M Ellingson  1   2   3   4 , Patrick Y Wen  5 , Timothy F Cloughesy  6   7
Affiliations
Review

Modified Criteria for Radiographic Response Assessment in Glioblastoma Clinical Trials

Benjamin M Ellingson et al. Neurotherapeutics. 2017 Apr.

Abstract

Radiographic endpoints including response and progression are important for the evaluation of new glioblastoma therapies. The current RANO criteria was developed to overcome many of the challenges identified with previous guidelines for response assessment, however, significant challenges and limitations remain. The current recommendations build on the strengths of the current RANO criteria, while addressing many of these limitations. Modifications to the current RANO criteria include suggestions for volumetric response evaluation, use contrast enhanced T1 subtraction maps to increase lesion conspicuity, removal of qualitative non-enhancing tumor assessment requirements, use of the post-radiation time point as the baseline for newly diagnosed glioblastoma response assessment, and "treatment-agnostic" response assessment rubrics for identifying pseudoprogression, pseudoresponse, and a confirmed durable response in newly diagnosed and recurrent glioblastoma trials.

Keywords: GBM; Glioblastoma; RANO; Response Assessment; T1 Subtraction.

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Figures

Fig. 1
Fig. 1
Construction of contrast enhanced T1-weighted subtraction maps in a recurrent glioblastoma patient treated with bevacizumab. A) Pre-contrast T1-weighted MR image. B) Post-contrast T1-weighted MR image. C) T1 subtraction map calculated by voxel-wise subtraction of pre-contrast from post-contrast T1-weighted images highlighting areas of increased contrast enhancement. Red arrows show two subtly enhancing lesions that are easily identified on T1 subtraction maps
Fig. 2
Fig. 2
Algorithm for identifying measurable and target lesions
Fig. 3
Fig. 3
Modified radiographic response assessment rubric for management of both pseudoprogression and pseudoresponse in newly diagnosed glioblastoma
Fig. 4
Fig. 4
Modified radiographic response assessment rubric for recurrent glioblastoma
See this image and copyright information in PMC

References

    1. Ostrom QT, Gittleman H, Fulop J et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008-2012. Neuro Oncol, 17 Suppl 4, iv1-iv62 (2015). - PMC - PubMed
    1. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987–996. - PubMed
    1. Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol. 2009;10(5):459–466. - PubMed
    1. Weller M, Cloughesy T, Perry JR, Wick W. Standards of care for treatment of recurrent glioblastoma—are we there yet? Neuro Oncol. 2013;15(1):4–27. - PMC - PubMed
    1. Chinot OL, Wick W, Mason W, et al. Bevacizumab plus radiotherapy-temozolomide for newly diagnosed glioblastoma. N Engl J Med. 2014;370(8):709–722. - PubMed

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