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. 2023 Oct 24;30(11):9382-9391.
doi: 10.3390/curroncol30110679.

Response Assessment in Brain Metastases Managed by Stereotactic Radiosurgery: A Reappraisal of the RANO-BM Criteria

Keiss Douri  1 , Christian Iorio-Morin  1 , Rosalie Mercure-Cyr  1 , Gabrielle Figueiredo  2 , Charles Jean Touchette  1 , Laurence Masson-Côté  3 , David Mathieu  1
Affiliations

Response Assessment in Brain Metastases Managed by Stereotactic Radiosurgery: A Reappraisal of the RANO-BM Criteria

Keiss Douri et al. Curr Oncol. .

Abstract

Background: Brain metastases (BM) are increasingly being treated using stereotactic radiosurgery (SRS). Standardized response criteria are necessary to improve research and treatment protocols. This study's goal was to validate the RANO-BM criteria thresholds for tumor progression in a cohort of patients with brain metastases managed using SRS.

Methods: We performed a retrospective analysis of patients treated at least twice with SRS for brain metastases. Local progression, as defined by RANO-BM criteria, was compared to our multidisciplinary tumor board's treatment recommendation. A ROC curve was generated using varying diameter thresholds to assess the sensitivity and specificity of current RANO-BM criteria.

Results: 249 metastases in 67 patients were included in the analysis. RANO-BM criteria current progression thresholds yielded a sensitivity of 38%, a specificity of 95%, a positive predictive value of 71%, and a negative predictive value of 84% relative to our tumor board's treatment recommendation. Modified RANO-BM criteria using absolute diameter differences of 2.5 mm yielded a sensitivity of 83%, a specificity of 87%, a positive predictive value of 67% and a negative predictive value of 94%.

Conclusions: Current RANO-BM criteria unreliably identifies clinically relevant tumor progression. The use of absolute diameter differences thresholds appears superior in our BM cohort.

Keywords: RANO-BM; brain metastases; criteria; diameter; progression; response.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Sixty-seven patients underwent two SRS procedures for the relapse of a previously treated metastasis or for progression of a different untreated metastasis. Fifty-eight metastases were treated twice with SRS.
Figure 2
Figure 2
Time to progression in metastases with tumoral and non-tumoral progression.
Figure 3
Figure 3
ROC curve of stratified RANO-BM score.
See this image and copyright information in PMC

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