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Challenges of Applying the RANO-BM Criteria for Characterization of Brain Metastases Treatment Response
Tatiana Kashtanova1, Naren Ramakrishna2,3
1Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA.
Abstract:
The goal of brain metastasis therapy is to reduce the risk of intracranial disease progression and to minimize treatment-related adverse effects and loss of neurologic function without compromising extracranial disease control. A response assessment system plays a critical role in the comparative evaluation of therapeutic strategies in clinical trials and in routine patient care. Since 2015, the RANO-BM criteria have become a standard schema for evaluating brain metastases treatment response, providing uniform definitions and methodology particularly practical in prospective clinical trials of systemic therapy. There have been a variety of modifications and additions to the original guidelines proposed to improve their utility for brain metastases response assessment, including lowering the measurable disease size threshold, optimizing disease progression metrics, and employing tumor volumetric analysis using automated measurement tools. However, despite these enhancements, the criteria display limitations in selected clinical scenarios. This article provides a detailed overview of these limitations and their corresponding clinical contexts and concludes with a discussion of approaches which may aid in the development of a more comprehensive brain metastases response assessment system.
Insights
The RANO-BM criteria help assess brain metastasis treatment response but have limitations. This review discusses these challenges and proposes improvements for better brain metastasis assessment.
Area of Science:
- Neurology
- Oncology
- Radiology
Background:
- Brain metastasis therapy aims to control intracranial progression and neurological function while managing side effects.
- Response assessment systems are crucial for evaluating treatments in clinical trials and patient care.
- The Response Assessment in Neuro-Oncology for Brain Metastases (RANO-BM) criteria, established in 2015, provide a standardized method for evaluating treatment response.
Purpose of the Study:
- To provide a comprehensive overview of the limitations of the current RANO-BM criteria for brain metastasis response assessment.
- To discuss the clinical contexts in which these limitations arise.
- To explore potential approaches for developing a more robust brain metastasis response assessment system.
Main Methods:
- Review of existing literature and clinical practices concerning RANO-BM criteria.
- Analysis of proposed modifications and additions to the original RANO-BM guidelines.
- Identification and discussion of specific clinical scenarios where RANO-BM criteria show limitations.
Main Results:
- The RANO-BM criteria have been enhanced with modifications like adjusted disease size thresholds, optimized progression metrics, and volumetric analysis.
- Despite enhancements, the RANO-BM criteria exhibit limitations in certain clinical situations.
- These limitations impact the precise evaluation of treatment efficacy and patient outcomes.
Conclusions:
- The current RANO-BM criteria, while valuable, require further refinement to address specific clinical challenges in brain metastasis assessment.
- Future developments should focus on incorporating advanced imaging and quantitative metrics.
- A more comprehensive assessment system is needed to improve the evaluation of novel therapies for brain metastases.
