Update to the RANO working group and EANO recommendations for the clinical use of PET imaging in gliomas

Norbert Galldiks¹, Philipp Lohmann², Mariam Aboian³, Ramon F Barajas Jr⁴, William G Breen⁵, Jana Ivanidze⁶, Derek R Johnson⁵, Timothy J Kaufmann⁵, Michelle M Kim⁷, Maximilian J Mair⁸, Giuseppe Minniti⁹, Michael Müther¹⁰, Ali Nabavizadeh¹¹, Joshua D Palmer¹², Roberta Rudà¹³, Marion Smits¹⁴, Nelleke Tolboom¹⁵, Sophie E M Veldhuijzen van Zanten¹⁴, Michael C Veronesi¹⁶, Jan-Michael Werner¹⁷, Martin van den Bent¹⁸, Susan M Chang¹⁹, Karl-Josef Langen²⁰, Ian Law²¹, Jonathan McConathy²², Minesh Mehta²³, Matthias Preusser²⁴, Susan C Short²⁵, Riccardo Soffietti²⁶, Michael Vogelbaum²⁷, Michael Weller²⁸, Patrick Y Wen²⁹, Joerg-Christian Tonn³⁰, Nathalie L Albert³¹

Affiliations

¹ Department of Neurology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany; Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany. Electronic address: norbert.galldiks@uk-koeln.de.
² Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany; Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany.
³ Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Radiology, Neuroradiology Section, Oregon Health & Science University, Portland, OR, USA; Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA; Translational Oncology Program, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
⁵ Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
⁶ Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
⁷ Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
⁸ Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Department of Nuclear Medicine, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.
⁹ Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed-Mediterranean Neurological Institute, Pozzilli, Italy.
¹⁰ Department of Neurosurgery, University Hospital Münster, Münster, Germany.
¹¹ Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
¹² Department of Radiation Oncology, The James Cancer Hospital, Ohio State University Wexner Medical Center, Columbus, OH, USA.
¹³ Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy.
¹⁴ 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.
¹⁵ Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands.
¹⁶ Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
¹⁷ Department of Neurology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
¹⁸ Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
¹⁹ Department of Neurological Surgery, Division of NeuroOncology, University of California, San Francisco, CA, USA.
²⁰ Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany; Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany; Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany.
²¹ Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark.
²² Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
²³ Department of Radiation Oncology, Florida International University and Miami Cancer Institute, Miami, FL, USA.
²⁴ Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
²⁵ Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK.
²⁶ Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy.
²⁷ Department of Neuro-Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
²⁸ Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
²⁹ Center For Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
³⁰ Department of Neurosurgery, University Hospital Munich, Ludwig-Maximilians-University and the German Cancer Consortium, Munich, Germany.
³¹ Department of Nuclear Medicine, University Hospital Munich, Ludwig-Maximilians-University and the German Cancer Consortium, Munich, Germany.

PMID: 40744043
DOI: 10.1016/S1470-2045(25)00193-7

Free article

Review

Update to the RANO working group and EANO recommendations for the clinical use of PET imaging in gliomas

Norbert Galldiks et al. Lancet Oncol. 2025 Aug.

Free article

. 2025 Aug;26(8):e436-e447.

doi: 10.1016/S1470-2045(25)00193-7.

Authors

Affiliations

¹ Department of Neurology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany; Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany. Electronic address: norbert.galldiks@uk-koeln.de.
² Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany; Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany.
³ Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Radiology, Neuroradiology Section, Oregon Health & Science University, Portland, OR, USA; Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA; Translational Oncology Program, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
⁵ Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
⁶ Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
⁷ Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
⁸ Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Department of Nuclear Medicine, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.
⁹ Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed-Mediterranean Neurological Institute, Pozzilli, Italy.
¹⁰ Department of Neurosurgery, University Hospital Münster, Münster, Germany.
¹¹ Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
¹² Department of Radiation Oncology, The James Cancer Hospital, Ohio State University Wexner Medical Center, Columbus, OH, USA.
¹³ Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy.
¹⁴ 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.
¹⁵ Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands.
¹⁶ Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
¹⁷ Department of Neurology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
¹⁸ Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
¹⁹ Department of Neurological Surgery, Division of NeuroOncology, University of California, San Francisco, CA, USA.
²⁰ Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany; Institute of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany; Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany.
²¹ Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark.
²² Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
²³ Department of Radiation Oncology, Florida International University and Miami Cancer Institute, Miami, FL, USA.
²⁴ Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
²⁵ Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK.
²⁶ Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy.
²⁷ Department of Neuro-Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
²⁸ Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
²⁹ Center For Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
³⁰ Department of Neurosurgery, University Hospital Munich, Ludwig-Maximilians-University and the German Cancer Consortium, Munich, Germany.
³¹ Department of Nuclear Medicine, University Hospital Munich, Ludwig-Maximilians-University and the German Cancer Consortium, Munich, Germany.

PMID: 40744043
DOI: 10.1016/S1470-2045(25)00193-7

Abstract

This Policy Review provides recommendations for the use of PET imaging in patients with gliomas and represents a joint effort of the Response Assessment in Neuro-Oncology (RANO) working group for PET and the European Association for Neuro-Oncology. The initial guideline was published in 2016, and summarised the previously established clinical benefit of PET with radiolabelled glucose and amino acid tracers in patients with gliomas. Since then, numerous additional studies have been published on this topic, focusing on differential diagnosis, prediction of molecular information, and prognostication. Further studies evaluated PET for biopsy guidance and delineation of glioma extent for local therapy planning, including resection and radiotherapy. In patients undergoing treatment, PET was studied for the assessment of response to local and systemic treatments and PET-based standardised response criteria (PET RANO 1.0) were proposed. In this Policy Review, the updated recommendations are based on evidence generated from studies that validated PET findings by histomolecular findings or clinical course. This guideline further underscores the previously reported clinical value of PET imaging and the superiority of amino acid PET over glucose PET, providing a framework for the use of PET in the management of patients with gliomas. The guideline also underscores the scarcity of class 1 evidence showing that incorporating PET imaging into clinical workflows improves patient outcomes, highlighting priority areas for future clinical studies designed to address this gap.

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Conflict of interest statement

Declaration of interests NG: honoraria for lectures from Blue Earth Diagnostics, for advisory board participation from Telix Pharmaceuticals and Servier, and for consultancy services from Telix Pharmaceuticals. PL: honoraria for lectures from Blue Earth Diagnostics and for advisory board participation from Servier. MA: research funding from Blue Earth Diagnostics, Cellectar, and US National Institutes of Health and National Cancer Institute (R01CA275767 and R21CA259964). RFB: honoraria from Telix Pharmaceuticals for consultancy services. WGB: honoraria for consultation or advisory board participation from GE Healthcare and Miltenyi Biomedicine (paid to institution). Research funding from Wayshine Biopharm. JI: research funding from GE Healthcare, Curium Pharma, and Novartis Pharmaceuticals (funds paid to institution). Travel supoport from Siemens Healthineers. DRJ: honoraria for consultation or advisory board participation from Novartis, Telix Pharmaceuticals, and Cellectar Pharmaceuticals. TJK: stock options from SpineThera. MMK: research funding from Blue Earth Diagnostics and US National Institutes of Health and National Cancer Institute (R50CA276015). MJM: research funding from Bristol Myers Squibb and travel support from Pierre Fabre. GM: honoraria for lectures, consultation, or advisory board participation from BrainLab, Accuray, Pfizer, AstraZeneca, Novocure, and Servier. MMü: honoraria for lectures, consultation, and travel cost reimbursement from Medac. Honoraria for consultation from ITM Oncologics. AN: honoraria for advisory board participation from Telix Pharmaceuticals and for consultancy services from Blue Earth Diagnostics. JDP: honoraria for advisory board participation for Servier, honoraria for consultant for ICOTEC, research grant from Genentech, research funding from US National Institutes of Health (R01CA269948). Spine Therapy Society steering committee co-chair. RR: honoraria for consultation, advisory board participation, or lectures from Novocure, Servier, CureVac, and Genenta. Research funding from Bayer. MS: honoraria for consultancy for Bracco (paid to institution) and speaker fees from the European School of Radiology (paid to institution). NT: honoraria for advisory board participation from Telix Pharmaceuticals and research funding from Curium Pharma. MCV: research support from Telix Pharmaceuticals and Blue Earth Diagnostics. Honoraria for invited talks, consultancy, participation on advisory boards, or steering committees from Telix Pharmaceuticals. MvdB: research support from Boehringer Ingelheim. Honoraria for consultancy or participation to advisory boards from Servier, Nuvation, Boehringer Ingelheim, Fore Biotherapeutics, Geneta, Incyte, Chimerix, AstraZeneca, Mundipharm, and Symbio Pharma. Travel support from Servier. K-JL: honoraria from Telix Pharmaceuticals for consultancy services. IL: honoraria for lectures and consultation from Telix Pharmaceuticals and Ribocure. JM: Honoraria from Telix Pharmaceuticals, GE Healthcare, Eli Lilly–Avid, and Novartis for consultancy services. Research support from GE Healthcare, Eli Lilly–Avid, and Cytosite Biopharma. MMe: honoraria for advisory board participation from Mevion Technological, and for consultancy services from AIQ, Telix Pharmaceuticals, Kazia, Novocure, Zap, and Xoft. Stock from Chimerix. MP: honoraria for lectures, consultation, or advisory board participation from Bayer, Bristol Myers Squibb, Novartis, Gerson Lehrman Group, CMC Contrast, GlaxoSmithKline, Mundipharma, Roche, BMJ Journals, MedMedia, AstraZeneca, AbbVie, Lilly, Medahead, Daiichi Sankyo, Sanofi, Merck Sharp & Dome, Tocagen, Adastra, Gan & Lee Pharmaceuticals, Janssen, Servier, Miltenyi, Boehringer Ingelheim, Telix Pharmaceuticals, Medscape, and OncLive. SCS: honoraria for lectures, advisory board participation, or research funding from Apollomics, CeCeVa, Chimerix, Medac, Mitenyi, Servier. RS: honoraria for consultation from Servier. MV: clinical trial funding to hospital from Oncosynergy, Infuseon, Celgene, and DeNovo. Honoraria from Servier, Biodexa, and Alexion. MW: research grants from Novartis, Quercis, and Versameb. Honoraria for lectures or advisory board participation or consulting from Anheart, Bayer, Curevac, Medac, Neurosense, Novartis, Novocure, Orbus, Pfizer, Philogen, Roche, and Servier. PYW: honoraria for advisory board and consultation from Alexion (AstraZeneca), Bristol Myers Squibb, Day One Bio, Fore Biotherapeutics, Genenta, GlaxoSmithKline, Kintara, Merck, Mundipharma, Novartis, Novocure, Nuvation Bio, Prelude Therapeutics, Sapience, Servier, and Telix Pharmaceuticals. Research Support from AstraZeneca, Black Diamond, Bristol Meyers Squibb, Chimerix, Eli Lily, Erasca, Global Coalition for Adaptive Research, Kazia, MediciNova, Merck, Nerviano, Novartis, Philogen, Quadriga, Servier, and VBI Vaccines. J-CT: honoraria for advice from Novartis and travel cost reimbursement from Servier. Novocure and Munich Surgical Imaging have supported clinical trials and contracted research conducted by J-CT with payments made to his institution. NLA: honoraria for lectures, consultation, or advisory board participation from Novartis, Advanced Accelerator Applications, Telix Pharmaceuticals, Servier, OncLive, and Medsir, and research funding from Novocure and Telix Pharmaceuticals. All other authors declare no competing interests.

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Update to the RANO working group and EANO recommendations for the clinical use of PET imaging in gliomas

Affiliations

Update to the RANO working group and EANO recommendations for the clinical use of PET imaging in gliomas

Authors

Affiliations

Abstract

Conflict of interest statement

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