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Published on: January 9, 2019
[Neuroradiological response criteria for malignant gliomas]
1Abteilung Neuroonkologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
Abstract:
This article summarizes the new response criteria of the Response Assessment in Neuro-Oncology (RANO) working group and the clinical implications. The RANO criteria represent an important step forward in the accurate assessment of response to therapy in patients with malignant gliomas, not only in clinical trials but also in daily practice. The introduction of new substances to glioma therapy, such as antiangiogenic drugs, has complicated the assessment of efficacy by MRI due to profound effects on the vascular biology of these tumors. Moreover new treatment modalities have increased the incidence and awareness of imaging phenomena, such as pseudoprogression and pseudoresponse, not only within clinical trials but also outside. In addition to MRI the new RANO criteria also take clinical parameters, such as steroid medication and neurological symptoms, into account. Thus both neuroradiologists and neurologists/neurooncologists need to be aware of and experienced in applying these criteria when treating patients with malignant gliomas to be able to correctly assess the response to therapy.
Insights
The new Response Assessment in Neuro-Oncology (RANO) criteria improve how doctors assess malignant glioma treatment response. These guidelines incorporate MRI, clinical symptoms, and steroid use for better accuracy in trials and daily practice.
Area of Science:
- Neuro-oncology
- Radiology
- Clinical trial methodology
Context:
- Malignant gliomas require accurate response assessment for effective treatment.
- New therapies like antiangiogenic drugs complicate MRI-based efficacy evaluation due to vascular effects.
- Imaging phenomena such as pseudoprogression and pseudoresponse are increasingly recognized.
Purpose:
- To summarize the updated Response Assessment in Neuro-Oncology (RANO) criteria.
- To discuss the clinical implications of these new RANO criteria for malignant glioma management.
- To highlight the importance of integrating MRI and clinical parameters for response assessment.
Summary:
- The article details the latest RANO working group criteria for assessing treatment response in malignant gliomas.
- These criteria enhance accuracy by combining Magnetic Resonance Imaging (MRI) findings with clinical factors like neurological status and steroid medication.
- The updated RANO guidelines address challenges posed by novel therapies and imaging artifacts like pseudoprogression.
Impact:
- The RANO criteria facilitate more precise evaluation of therapeutic efficacy in clinical trials and routine patient care.
- Accurate assessment using RANO guidelines aids in timely treatment adjustments for patients with malignant gliomas.
- Neuroradiologists and neuro-oncologists must be proficient in applying RANO criteria for optimal patient management.
