Response assessment in neuro-oncology

Area of Science:

• Neuro-oncology
• Radiology
• Oncology

Background:

• Assessing treatment response and tumor progression in nervous system tumors presents significant accuracy and reproducibility challenges.
• Existing response criteria are often pathology-specific and possess inherent limitations.
• The Macdonald criteria, based on 2D measurements, were historically standard for gliomas.

Purpose of the Study:

• To review current response assessment criteria for various nervous system tumors.
• To highlight the evolution from Macdonald criteria to the newer Response Assessment in Neuro-Oncology (RANO) guidelines.
• To provide an overview of criteria for high-grade glioma, low-grade glioma, brain metastasis, meningioma, and schwannoma.

Main Methods:

• Literature review of established and emerging response assessment criteria.
• Comparative analysis of traditional and novel neuroimaging-based criteria.
• Synthesis of recommendations from the Response Assessment in Neuro-Oncology (RANO) Working Group.

Main Results:

• The Macdonald criteria, while historically significant for gliomas, have limitations.
• The Response Assessment in Neuro-Oncology (RANO) Working Group has introduced updated recommendations for high-grade gliomas.
• RANO is developing guidelines for other nervous system tumor types.

Conclusions:

• Accurate assessment of treatment response and tumor progression in nervous system tumors requires standardized and validated criteria.
• The shift towards RANO criteria signifies an advancement in neuro-oncology response assessment.
• This review provides a comprehensive overview of current standards for key nervous system tumor types.