Skip to main content

Advertisement

Log in

Neuroradiological Response Criteria for High-grade Gliomas

  • Review Article
  • Published:
Clinical Neuroradiology Aims and scope Submit manuscript

Abstract

The recently introduced new response criteria of the response assessment in neuro-oncology (RANO) working group and its clinical implications are the topic of this article. Establishing this working group as a work-in-progress platform and its first report, 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. Anti-angiogenic therapy and other new treatment modalities have increased the incidence and awareness of novel imaging phenomena, such as pseudoprogression and pseudoresponse not only within clinical trials. The new RANO criteria also take clinical parameters, such as steroid medication and neurological symptoms into account. Neuroradiologists and neuro-oncologists need to be aware of and experienced in applying these new criteria to correctly assess the response to treatment in patients with malignant gliomas. Further research is needed to study new imaging techniques, such as perfusion and diffusion-weighted imaging and to investigate and incorporate these for routine tumor response criteria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Macdonald DR, Cascino TL, Schold SC, Jr, Cairncross JG. Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol. 1990;8:1277–80.

    PubMed  CAS  Google Scholar 

  2. Levin VA, Crafts DC, Norman DM, Hoffer PB, Spire JP, Wilson CB. Criteria for evaluating patients undergoing chemotherapy for malignant brain tumors. J Neurosurg. 1977;47(3):329–35.

    Article  PubMed  CAS  Google Scholar 

  3. Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, et al. Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol. 2010;28(11):1963–72.

    Article  PubMed  Google Scholar 

  4. van den Bent MJ, Vogelbaum MA, Wen PY, Macdonald DR, Chang SM. End point assessment in gliomas: novel treatments limit usefulness of classical Macdonald’s Criteria. J Clin Oncol. 2009;27(18):2905–08.

    Article  PubMed  Google Scholar 

  5. FDA, Clinical Trial Endpoints for the Approval of Cancer Drugs and Biologics. US Department of Health and Human Services. 2007.

  6. Wen PY, Norden AD, Drappatz J, Quant E. Response assessment challenges in clinical trials of gliomas. Curr Oncol Rep. 2010;12(1):68–75.

    Article  PubMed  Google Scholar 

  7. Stupp R, Mason WP, Van Den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. New Engl J Med. 2005;352:987–96.

    Article  PubMed  CAS  Google Scholar 

  8. Taal W, Brandsma D, De Bruin HG, Bromberg JE, Swaak-Kragten AT, Smitt PA, et al. Incidence of early pseudo-progression in a cohort of malignant glioma patients treated with chemoirradiation with temozolomide. Cancer. 2008;113:405–10.

    Article  PubMed  CAS  Google Scholar 

  9. Kumar AJ, Leeds NE, Fuller GN, Van Tassel P, Maor MH, Sawaya RE, Levin VA. Malignant gliomas: MR imaging spectrum of radiation therapy- and chemotherapy-induced necrosis of the brain after treatment. Radiology. 2000;217(2):377–84.

    PubMed  CAS  Google Scholar 

  10. Brandsma D, Stalpers L, Taal W, Sminia P, van den Bent MJ. Clinical features, mechanisms, and management of pseudoprogression in malignant gliomas. Lancet Oncol. 2008;9:453–61.

    Article  PubMed  Google Scholar 

  11. Bendszus M, Platten M. Neuroradiologische Responsekriterien bei malignen Gliomen. Nervenarzt. 2010;81:950–55.

    Article  PubMed  CAS  Google Scholar 

  12. Brandes AA, Franceschi E, Tosoni A, Blatt V, Pession A, Tallini G, et al. MGMT promoter methylation status can predict the incidence and outcome of pseudoprogression after concomitant radiochemotherapy in newly diagnosed glioblastoma patients. J Clin Oncol. 2008;26:2192–7.

    Article  PubMed  Google Scholar 

  13. Batchelor TT, Sorensen AG, Di Tomaso E, Zhang WT, Duda DG, Cohen KS, et al. AZD2171, a pan-VEGF receptor tyrosine kinase inhibitor, normalizes tumor vasculature and alleviates edema in glioblastoma patients. Cancer Cell. 2007;11:83–95.

    Article  PubMed  CAS  Google Scholar 

  14. Vredenburgh JJ, Desjardins A, Herndon JE 2nd, Marcello J, Reardon DA, Quinn JA, et al. Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol. 2007;25:4722–9.

    Article  PubMed  CAS  Google Scholar 

  15. Vredenburgh JJ, Desjardins A, Herndon JE 2nd, Dowell JM, Reardon DA, Quinn JA, et al. Phase II trial of bevacizumab and irinotecan in recurrent malignant glioma. Clin Cancer Res. 2007;13:1253–9.

    Article  PubMed  CAS  Google Scholar 

  16. Batchelor TT, Duda DG, Di Tomaso E, Ancukiewicz M, Plotkin SR, Gerstner E, et al. Phase II study of cediranib, an oral pan-vascular endothelial growth factor receptor tyrosine kinase inhibitor, in patients with recurrent glioblastoma. J Clin Oncol. 2010;10;28(17):2817–23.

    Article  PubMed  CAS  Google Scholar 

  17. Wick W, Weller M, Van Den Bent M, Stupp R. Bevacizumab and recurrent malignant gliomas: a European perspective. J Clin Oncol. 2010;28:e188-9; author reply e190–82.

    Article  PubMed  Google Scholar 

  18. Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM, editor. Evaluation of chemotherapeutic agents. New York: Columbia University Press; 1949; S. 196.

    Google Scholar 

  19. Tsien C, Galban CJ, Chenevert TL, Johnson TD, Hamstra DA, Sundgren PC, et al. Parametric response map as an imaging biomarker to distinguish progression from pseudoprogression in high-grade glioma. J Clin Oncol. 2010;28:2293–9.

    Article  PubMed  CAS  Google Scholar 

  20. Heiland S, Wick W, Bendszus M. Perfusion MRI for parametric response maps in tumors: is it really that easy? J Clin Oncol. 2010;10;28(29):e591.

    Article  PubMed  Google Scholar 

  21. Radbruch A, Bendszus M, Wick W, Heiland S. Comment to: parametric response map as an imaging biomarker to distinguish progression from pseudoprogression in high-grade glioma: pitfalls in perfusion MRI in brain tumors : Tsien C, Galbán CJ, Chenevert TL, Johnson TD, Hamstra DA, Sundgren PC, Junck L, Meyer CR, Rehemtulla A, Lawrence T, Ross BD. J Clin Oncol. 28:2293-9, Clin Neuroradiol. 2010;20(3):183–4.

    Article  Google Scholar 

  22. Di Costanzo A, Scarabino T, Trojsi F, Popolizio T, Catapano D, Giannatempo GM, et al. (2008) Proton MR spectroscopy of cerebral gliomas at 3 T: spatial heterogeneity, and tumour grade and extent. Eur Radiol 18:1727–1735.

    Article  PubMed  Google Scholar 

  23. Yang I, Aghi MK (2009) New advances that enable identification of glioblastoma recurrence. Nat Rev Clin Oncol 6:648–657.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors declare that there are no actual or potential conflicts of interest in relation to this article.

Dedicated to Prof. Laszlo Solymosi for his 60 th birthday

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Radbruch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lutz, K., Radbruch, A., Wiestler, B. et al. Neuroradiological Response Criteria for High-grade Gliomas. Clin Neuroradiol 21, 199–205 (2011). https://doi.org/10.1007/s00062-011-0080-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00062-011-0080-7

Keywords

Navigation