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Clinical Trial
. 2017 Jun 1;19(6):853-861.
doi: 10.1093/neuonc/now311.

Comparison of 2D (RANO) and volumetric methods for assessment of recurrent glioblastoma treated with bevacizumab-a report from the BELOB trial

Renske Gahrmann  1 , Martin van den Bent  2 , Bronno van der Holt  3 , René Michel Vernhout  3 , Walter Taal  2 , Maaike Vos  4 , Jan Cees de Groot  5 , Laurens Victor Beerepoot  6 , Jan Buter  7 , Zwenneke Hendrieke Flach  8 , Monique Hanse  9 , Bas Jasperse  10 , Marion Smits  1
Affiliations
Clinical Trial

Comparison of 2D (RANO) and volumetric methods for assessment of recurrent glioblastoma treated with bevacizumab-a report from the BELOB trial

Renske Gahrmann et al. Neuro Oncol. .

Abstract

Background: The current method for assessing progressive disease (PD) in glioblastoma is according to the Response Assessment in Neuro-Oncology (RANO) criteria. Bevacizumab-treated patients may show pseudo-response on postcontrast T1-weighted (T1w) MRI, and a more infiltrative non-enhancing growth pattern on T2w/fluid attenuated inversion recovery (FLAIR) images. We investigated whether the RANO criteria remain the method of choice for assessing bevacizumab-treated recurrent glioblastoma when compared with various volumetric methods.

Methods: Patients with assessable MRI data from the BELOB trial (n = 148) were included. Patients were treated with bevacizumab, lomustine, or both. At first and second radiological follow-up (6 and 12 wk), PD was determined using the 2D RANO criteria and various volumetric methods based on enhancing tumor only and enhancing plus non-enhancing tumor. Differences in overall survival (OS) between PD and non-PD patients were assessed with the log-rank test and a Cox model. Hazard ratios (HRs) and their 95% CIs were determined.

Results: For all patients together, all methods (except subtraction of non-enhancing from enhancing volume at first follow-up) showed significant differences in OS between PD and non-PD patients (P < .001). The largest risk increase for death in case of PD at both first and second follow-up was found with the RANO criteria: HR = 2.81 (95% CI, 1.92-4.10) and HR = 2.80 (95% CI, 1.75-4.49), respectively. In the bevacizumab-treated patients, all methods assessed showed significant differences in OS between PD and non-PD patients. There were no significant differences between methods.

Conclusions: In the first 12 weeks, volumetric methods did not provide significant improvement over the RANO criteria as a posttreatment prognostic marker.

Keywords: RANO; bevacizumab; recurrent glioblastoma; volumetry.

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Figures

Fig. 1
Fig. 1
Example of segmentation in Brainlab iPlan 4.0 Cranial using inclusion (green) and exclusion (blue) lines/points in the axial plane (A) and the resulting segmentation (B).
Fig. 2
Fig. 2
Kaplan–Meier curves of all progressive (PD) versus non-progressive (non-PD) patients for each of the methods at first follow-up. (A) 2D RANO, (B) contrast-enhancing volume, (C) subtraction volume, (D) contrast-enhancing + FLAIR volume, and (E) subtraction + FLAIR volume.
Fig. 3
Fig. 3
Kaplan–Meier curves of all progressive (PD) versus non-progressive (non-PD) patients for each of the methods at second follow-up. (A) 2D RANO, (B) contrast-enhancing volume, (C) subtraction volume, (D) contrast-enhancing + FLAIR volume, and (E) subtraction + FLAIR volume.
Fig. 4
Fig. 4
Kaplan–Meier curves of progressive (PD) versus non-progressive (non-PD) bevacizumab-treated patients only for methods with sufficient power (>80%) at first follow-up. (A) 2D RANO, (B) contrast-enhancing volume, (C) contrast-enhancing + FLAIR volume, and (D) subtraction + FLAIR volume. And at second follow-up (E) 2D RANO, and (F) contrast-enhancing + FLAIR volume.
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Comment in

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