Modified Criteria for Radiographic Response Assessment in Glioblastoma Clinical Trials

Benjamin M Ellingson; Patrick Y Wen; Timothy F Cloughesy

doi:10.1007/s13311-016-0507-6

Modified Criteria for Radiographic Response Assessment in Glioblastoma Clinical Trials

Neurotherapeutics. 2017 Apr;14(2):307-320. doi: 10.1007/s13311-016-0507-6.

Authors

Benjamin M Ellingson^{1

2

3

4}, Patrick Y Wen⁵, Timothy F Cloughesy^{6

7}

Affiliations

¹ UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA. bellingson@mednet.ucla.edu.
² Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA. bellingson@mednet.ucla.edu.
³ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. bellingson@mednet.ucla.edu.
⁴ UCLA Neuro-Oncology Program, University of California Los Angeles, Los Angeles, CA, USA. bellingson@mednet.ucla.edu.
⁵ Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA.
⁶ UCLA Neuro-Oncology Program, University of California Los Angeles, Los Angeles, CA, USA.
⁷ Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.

Abstract

Radiographic endpoints including response and progression are important for the evaluation of new glioblastoma therapies. The current RANO criteria was developed to overcome many of the challenges identified with previous guidelines for response assessment, however, significant challenges and limitations remain. The current recommendations build on the strengths of the current RANO criteria, while addressing many of these limitations. Modifications to the current RANO criteria include suggestions for volumetric response evaluation, use contrast enhanced T1 subtraction maps to increase lesion conspicuity, removal of qualitative non-enhancing tumor assessment requirements, use of the post-radiation time point as the baseline for newly diagnosed glioblastoma response assessment, and "treatment-agnostic" response assessment rubrics for identifying pseudoprogression, pseudoresponse, and a confirmed durable response in newly diagnosed and recurrent glioblastoma trials.

Keywords: GBM; Glioblastoma; RANO; Response Assessment; T1 Subtraction.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Brain / drug effects
Brain / pathology
Brain Neoplasms / diagnostic imaging*
Brain Neoplasms / pathology*
Brain Neoplasms / therapy*
Clinical Trials as Topic
Disease Progression
Glioblastoma / diagnostic imaging*
Glioblastoma / pathology*
Glioblastoma / therapy*
Humans
Image Enhancement
Image Interpretation, Computer-Assisted
Magnetic Resonance Imaging*
Treatment Outcome