Review

. 2024 Jan;25(1):e29-e41.

doi: 10.1016/S1470-2045(23)00525-9.

PET-based response assessment criteria for diffuse gliomas (PET RANO 1.0): a report of the RANO group

Nathalie L Albert¹, Norbert Galldiks², Benjamin M Ellingson³, Martin J van den Bent⁴, Susan M Chang⁵, Francesco Cicone⁶, John de Groot⁵, Eng-Siew Koh⁷, Ian Law⁸, Emilie Le Rhun⁹, Maximilian J Mair¹⁰, Giuseppe Minniti¹¹, Roberta Rudà¹², Andrew M Scott¹³, Susan C Short¹⁴, Marion Smits¹⁵, Bogdana Suchorska¹⁶, Nelleke Tolboom¹⁷, Tatjana Traub-Weidinger¹⁸, Joerg-Christian Tonn¹⁹, Antoine Verger²⁰, Michael Weller²¹, Patrick Y Wen²², Matthias Preusser²³

Affiliations

¹ Department of Nuclear Medicine, LMU Hospital, LMU Munich, Munich, Germany.
² Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany; Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany.
³ UCLA Brain Tumor Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
⁴ The Brain Tumour Center at the Erasmus MC Cancer Institute, Rotterdam, Netherlands.
⁵ Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
⁶ Nuclear Medicine Unit, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy.
⁷ Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centre, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.
⁸ Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark.
⁹ Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
¹⁰ Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
¹¹ Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy; IRCCS Neuromed, Pozzilli IS, Italy.
¹² Division of Neuro-Oncology, Department of Neuroscience, University of Turin and City of Health and Science of Turin, Turin, Italy.
¹³ Department of Molecular Imaging and Therapy, Austin Health and University of Melbourne, Melbourne, VIC, Australia; Olivia Newton-John Cancer Research Institute and School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia.
¹⁴ Leeds Institute of Medical Research at St James's, The University of Leeds, Leeds, UK.
¹⁵ Department of Radiology & Nuclear Medicine, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, Netherlands; Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, Netherlands; Medical Delta, Delft, Netherlands.
¹⁶ Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
¹⁷ Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands.
¹⁸ Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
¹⁹ Department of Neurosurgery, LMU Hospital, LMU Munich, Munich, Germany.
²⁰ Department of Nuclear Medicine & Nancyclotep Imaging Platform, CHRU Nancy and IADI INSERM UMR 1254, Universitè de Lorraine, Nancy, France.
²¹ Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Department of Neurology, University of Zurich, Zurich, Switzerland.
²² Center For Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
²³ Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria. Electronic address: matthias.preusser@meduniwien.ac.at.

PMID: 38181810
PMCID: PMC11787868
DOI: 10.1016/S1470-2045(23)00525-9

Review

PET-based response assessment criteria for diffuse gliomas (PET RANO 1.0): a report of the RANO group

Nathalie L Albert et al. Lancet Oncol. 2024 Jan.

. 2024 Jan;25(1):e29-e41.

doi: 10.1016/S1470-2045(23)00525-9.

Authors

Affiliations

¹ Department of Nuclear Medicine, LMU Hospital, LMU Munich, Munich, Germany.
² Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany; Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany.
³ UCLA Brain Tumor Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
⁴ The Brain Tumour Center at the Erasmus MC Cancer Institute, Rotterdam, Netherlands.
⁵ Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
⁶ Nuclear Medicine Unit, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy.
⁷ Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centre, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.
⁸ Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark.
⁹ Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
¹⁰ Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
¹¹ Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy; IRCCS Neuromed, Pozzilli IS, Italy.
¹² Division of Neuro-Oncology, Department of Neuroscience, University of Turin and City of Health and Science of Turin, Turin, Italy.
¹³ Department of Molecular Imaging and Therapy, Austin Health and University of Melbourne, Melbourne, VIC, Australia; Olivia Newton-John Cancer Research Institute and School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia.
¹⁴ Leeds Institute of Medical Research at St James's, The University of Leeds, Leeds, UK.
¹⁵ Department of Radiology & Nuclear Medicine, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, Netherlands; Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, Netherlands; Medical Delta, Delft, Netherlands.
¹⁶ Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
¹⁷ Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands.
¹⁸ Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
¹⁹ Department of Neurosurgery, LMU Hospital, LMU Munich, Munich, Germany.
²⁰ Department of Nuclear Medicine & Nancyclotep Imaging Platform, CHRU Nancy and IADI INSERM UMR 1254, Universitè de Lorraine, Nancy, France.
²¹ Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Department of Neurology, University of Zurich, Zurich, Switzerland.
²² Center For Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
²³ Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria. Electronic address: matthias.preusser@meduniwien.ac.at.

PMID: 38181810
PMCID: PMC11787868
DOI: 10.1016/S1470-2045(23)00525-9

Abstract

Response Assessment in Neuro-Oncology (RANO) response criteria have been established and were updated in 2023 for MRI-based response evaluation of diffuse gliomas in clinical trials. In addition, PET-based imaging with amino acid tracers is increasingly considered for disease monitoring in both clinical practice and clinical trials. So far, a standardised framework defining timepoints for baseline and follow-up investigations and response evaluation criteria for PET imaging of diffuse gliomas has not been established. Therefore, in this Policy Review, we propose a set of criteria for response assessment based on amino acid PET imaging in clinical trials enrolling participants with diffuse gliomas as defined in the 2021 WHO classification of tumours of the central nervous system. These proposed PET RANO criteria provide a conceptual framework that facilitates the structured implementation of PET imaging into clinical research and, ultimately, clinical routine. To this end, the PET RANO 1.0 criteria are intended to encourage specific investigations of amino acid PET imaging of gliomas.

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Conflict of interest statement

Declaration of interests NLA has received honoraria for consultation or advisory board participation from Novartis (Advanced Accelerator Applications), Telix Pharmaceuticals, and Servier; and research funding from Novocure. NG received honoraria for lectures from Blue Earth Diagnostics and honoraria for advisory board participation from Telix Pharmaceuticals. BME is on the advisory board and is a paid consultant for Medicenna, MedQIA, Servier Pharmaceuticals, Siemens, Janssen Pharmaceuticals, Imaging Endpoints, Kazia, Chimerix, Sumitomo Dainippon Pharma Oncology, ImmunoGenesis, Ellipses Pharma, Monteris, Neosoma, Alpheus Medical, Sagimet Biosciences, Sapience Therapeutics, Orbus Therapeutics, and the Global Coalition for Adaptive Research. MJvdB has received honoraria from Roche, AstraZeneca, Servier, Boehringer, Genenta, Fore Biotherapeutics, Incyte, and Nerviano. ELR reports personal financial interests as an advisory board member for Bayer, Janssen, Leo Pharma, Pierre Fabre, Roche, Seattle Genetics, and Servier; and institutional funding from Bristol Myers Squibb. MJM has received research support from Bristol Myers Squibb and travel support from Pierre Fabre. GM has received honoraria for lectures from BrainLab. RR has received research grants from Bayer, and honoraria for lectures or consulting from UCB, Novocure, Genenta, Curevac, and Servier. AMS has received research support to his institution from Medimmune, AVID, Telix Pharmaceuticals, ITM, Fusion, Cyclotek, Adalta, TheraMyc, Curis, Humanigen, and Antengene; funding support from the Medical Research Future Fund, Australian Brain Cancer Mission, Cure Brain Cancer Foundation, National Breast Cancer Foundation, Australian Cancer Research Foundation, National Imaging Facility, and Victorian Cancer Agency; and is a National Health and Medical Research Council Investigator. MS has received honoraria for consultancy from Bracco and honoraria for lectures from GE Healthcare, AuntMinnie, and Fondazione Internazionale Menarini (all paid to their institution). BS has received honoraria for lectures and consultation from Novocure. J-CT has received honoraria for lectures, consultation, or advisory board participation from SeagGen, AAA-Novartis, Novocure, and Munich Surgical Imaging. AV has received honoraria for lectures and advisory board participation from Curium, Eisai, and General Electrics. MW has received research grants from Quercis and Versameb; and honoraria for lectures or advisory board participation or consulting from Bayer, Curevac, Medac, Novartis, Novocure, Orbus, Philogen, Roche, and Servier. PYW has received research support from AstraZeneca, Black Diamond, Bristol Myers Squibb, Celgene, Chimerix, Eli Lilly, Erasca, Genentech/Roche, Kazia, MediciNova, Merck, Novartis, Nuvation Bio, Servier, Vascular Biogenics, and VBI Vaccines; and honoraria for serving as a consultant or on advisory boards for AstraZeneca, Black Diamond, Celularity, Chimerix, Day One Bio, Genenta, GSK, Merck, Mundipharma, Novartis, Novocure, Nuvation Bio, Prelude Therapeutics, Sapience, Servier, Sagimet, Vascular Biogenics, and VBI Vaccines. MP has received honoraria for lectures, consultation, or advisory board participation from Bayer, Bristol Myers Squibb, Novartis, Gerson Lehrman Group, CMC Contrast, GSK, Mundipharma, Roche, BMJ Journals, MedMedia, AstraZeneca, AbbVie, Lilly, Medahead, Daiichi Sankyo, Sanofi, Merck Sharp & Dohme, Tocagen, Adastra, Gan & Lee Pharmaceuticals, and Servier; and travel support from Servier, Roche, and Medsir.

Figures

**Figure 1:. Exemplary definition of a crescent-shaped VOI and of the PET-positive volume**
VOI=volume of interest. ROI=region of interest. SUV=standardised uptake value. TBR=target-to-background ratio.

**Figure 2:. Definitions of no measurable disease, non-measurable disease, and measurable disease per the PET RANO 1.0 criteria**
RANO=Response Assessment in Neuro-Oncology. TBR=target-to-background ratio.

**Figure 3:. Visualisation of the PET RANO 1.0 criteria**
NA=not applicable. RANO=Response Assessment in Neuro-Oncology. *Not a possible outcome.

See this image and copyright information in PMC

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PET-based response assessment criteria for diffuse gliomas (PET RANO 1.0): a report of the RANO group

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PET-based response assessment criteria for diffuse gliomas (PET RANO 1.0): a report of the RANO group

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