Pros and cons of current brain tumor imaging

Area of Science:

• Neuro-oncology
• Radiology
• Clinical Trial Design

Background:

• Limited approval of new agents for brain tumor treatment over two decades.
• Significant challenges exist in evaluating the efficacy of novel therapeutic agents for brain tumors.
• Traditional oncology endpoints like overall survival are insufficient for neuro-oncology.

Purpose of the Study:

• To review key challenges in assessing tumor response to therapy in adult high-grade gliomas.
• To discuss the strengths and limitations of various imaging-based endpoints in neuro-oncology.
• To highlight advancements in neuro-oncology endpoints since the 2006 Brain Tumor Endpoints Workshop.

Main Methods:

• Review of literature and advancements in neuro-oncology endpoint assessment.
• Focus on imaging-based endpoints, including T2/fluid-attenuated inversion recovery (FLAIR).
• Discussion of Response Assessment in Neuro-Oncology (RANO) criteria.

Main Results:

• Progression-free survival and response rate are valuable endpoints in neuro-oncology.
• RANO criteria improve the assessment of tumor response in clinical trials.
• Evaluation of pseudoprogression, pseudoresponse, and inflammatory responses in radiographic images is crucial.

Conclusions:

• Imaging endpoints, particularly RANO criteria, are essential for evaluating novel agents in high-grade gliomas.
• Objective response rates and progression-free survival are critical in clinical trial design.
• Accurate interpretation of radiographic changes, including pseudoprogression, is vital for effective treatment assessment.