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

Patrick Y Wen¹, Martin van den Bent², Gilbert Youssef¹, Timothy F Cloughesy³, Benjamin M Ellingson⁴, Michael Weller⁵, Evanthia Galanis⁶, Daniel P Barboriak⁷, John de Groot⁸, Mark R Gilbert⁹, Raymond Huang¹⁰, Andrew B Lassman¹¹, Minesh Mehta¹², Annette M Molinaro¹³, Matthias Preusser¹⁴, Rifaquat Rahman¹⁵, Lalitha K Shankar¹⁶, Roger Stupp¹⁷, Javier E Villanueva-Meyer¹⁸, Wolfgang Wick¹⁹, David R Macdonald²⁰, David A Reardon¹, Michael A Vogelbaum²¹, Susan M Chang⁸

Affiliations

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.

PMID: 37774317
PMCID: PMC10860967
DOI: 10.1200/JCO.23.01059

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

Patrick Y Wen et al. J Clin Oncol. 2023.

. 2023 Nov 20;41(33):5187-5199.

doi: 10.1200/JCO.23.01059. Epub 2023 Sep 29.

Authors

Affiliations

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.

PMID: 37774317
PMCID: PMC10860967
DOI: 10.1200/JCO.23.01059

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.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

References

1. Ostrom QT, Price M, Neff C, et al. CBTRUS statistical report: Primary brain and other central nervous system tumors diagnosed in the United States in 2015-2019. Neuro Oncol. 2022;24:v1–v95. - PMC - PubMed
1. Weller M, van den Bent M, Preusser M, et al. EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol. 2021;18:170–186. - PMC - PubMed
1. Miller JJ, Gonzalez Castro LN, McBrayer S, et al. Isocitrate dehydrogenase (IDH) mutant gliomas: A Society for Neuro-Oncology (SNO) consensus review on diagnosis, management, and future directions. Neuro Oncol. 2023;25:4–25. - PMC - PubMed
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1. Wen PY, Macdonald DR, Reardon DA, et al. Updated response assessment criteria for high-grade gliomas: Response assessment in neuro-oncology working group. J Clin Oncol. 2010;28:1963–1972. - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical