A Neuroradiologist's Guide to Operationalizing the Response Assessment in Neuro-Oncology (RANO) Criteria Version 2.0 for Gliomas in Adults

Benjamin M Ellingson; Francesco Sanvito; Timothy F Cloughesy; Raymond Y Huang; Javier E Villanueva-Meyer; Whitney B Pope; Daniel P Barboriak; Lalitha K Shankar; Marion Smits; Timothy J Kaufmann; Jerrold L Boxerman; Michael Weller; Evanthia Galanis; John de Groot; Mark R Gilbert; Andrew B Lassman; Mark S Shiroishi; Ali Nabavizadeh; Minesh Mehta; Roger Stupp; Wolfgang Wick; David A Reardon; Michael A Vogelbaum; Martin van den Bent; Susan M Chang; Patrick Y Wen

doi:10.3174/ajnr.A8396

A Neuroradiologist's Guide to Operationalizing the Response Assessment in Neuro-Oncology (RANO) Criteria Version 2.0 for Gliomas in Adults

Benjamin M Ellingson, Francesco Sanvito, Timothy F Cloughesy, Raymond Y Huang, Javier E Villanueva-Meyer, Whitney B Pope, Daniel P Barboriak, Lalitha K Shankar, Marion Smits, Timothy J Kaufmann, Jerrold L Boxerman, Michael Weller, Evanthia Galanis, John de Groot, Mark R Gilbert, Andrew B Lassman, Mark S Shiroishi, Ali Nabavizadeh, Minesh Mehta, Roger StuppWolfgang Wick, David A Reardon, Michael A Vogelbaum, Martin van den Bent, Susan M Chang, Patrick Y Wen

Research output: Contribution to journal › Review article › peer-review

Abstract

Radiographic assessment plays a crucial role in the management of patients with central nervous system (CNS) tumors, aiding in treatment planning and evaluation of therapeutic efficacy by quantifying response. Recently, an updated version of the Response Assessment in Neuro-Oncology (RANO) criteria (RANO 2.0) was developed to improve upon prior criteria and provide an updated, standardized framework for assessing treatment response in clinical trials for gliomas in adults. This article provides an overview of significant updates to the criteria including (1) the use of a unified set of criteria for high and low grade gliomas in adults; (2) the use of the post-radiotherapy MRI scan as the baseline for evaluation in newly diagnosed high-grade gliomas; (3) the option for the trial to mandate a confirmation scan to more reliably distinguish pseudoprogression from tumor progression; (4) the option of using volumetric tumor measurements; and (5) the removal of subjective non-enhancing tumor evaluations in predominantly enhancing gliomas (except for specific therapeutic modalities). Step-by-step pragmatic guidance is hereby provided for the neuroradiologist and imaging core lab involved in operationalization and technical execution of RANO 2.0 in clinical trials, including the display of representative cases and in-depth discussion of challenging scenarios.

Original language	English
Journal	American Journal of Neuroradiology
DOIs	https://doi.org/10.3174/ajnr.A8396
State	E-pub ahead of print - Aug 5 2024
Externally published	Yes

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10.3174/ajnr.A8396

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Ellingson, B. M., Sanvito, F., Cloughesy, T. F., Huang, R. Y., Villanueva-Meyer, J. E., Pope, W. B., Barboriak, D. P., Shankar, L. K., Smits, M., Kaufmann, T. J., Boxerman, J. L., Weller, M., Galanis, E., Groot, J. D., Gilbert, M. R., Lassman, A. B., Shiroishi, M. S., Nabavizadeh, A., Mehta, M., ... Wen, P. Y. (2024). A Neuroradiologist's Guide to Operationalizing the Response Assessment in Neuro-Oncology (RANO) Criteria Version 2.0 for Gliomas in Adults. American Journal of Neuroradiology. Advance online publication. https://doi.org/10.3174/ajnr.A8396

Ellingson, BM, Sanvito, F, Cloughesy, TF, Huang, RY, Villanueva-Meyer, JE, Pope, WB, Barboriak, DP, Shankar, LK, Smits, M, Kaufmann, TJ, Boxerman, JL, Weller, M, Galanis, E, Groot, JD, Gilbert, MR, Lassman, AB, Shiroishi, MS, Nabavizadeh, A, Mehta, M, Stupp, R, Wick, W, Reardon, DA, Vogelbaum, MA, van den Bent, M, Chang, SM & Wen, PY 2024, 'A Neuroradiologist's Guide to Operationalizing the Response Assessment in Neuro-Oncology (RANO) Criteria Version 2.0 for Gliomas in Adults', American Journal of Neuroradiology. https://doi.org/10.3174/ajnr.A8396

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title = "A Neuroradiologist's Guide to Operationalizing the Response Assessment in Neuro-Oncology (RANO) Criteria Version 2.0 for Gliomas in Adults",

abstract = "Radiographic assessment plays a crucial role in the management of patients with central nervous system (CNS) tumors, aiding in treatment planning and evaluation of therapeutic efficacy by quantifying response. Recently, an updated version of the Response Assessment in Neuro-Oncology (RANO) criteria (RANO 2.0) was developed to improve upon prior criteria and provide an updated, standardized framework for assessing treatment response in clinical trials for gliomas in adults. This article provides an overview of significant updates to the criteria including (1) the use of a unified set of criteria for high and low grade gliomas in adults; (2) the use of the post-radiotherapy MRI scan as the baseline for evaluation in newly diagnosed high-grade gliomas; (3) the option for the trial to mandate a confirmation scan to more reliably distinguish pseudoprogression from tumor progression; (4) the option of using volumetric tumor measurements; and (5) the removal of subjective non-enhancing tumor evaluations in predominantly enhancing gliomas (except for specific therapeutic modalities). Step-by-step pragmatic guidance is hereby provided for the neuroradiologist and imaging core lab involved in operationalization and technical execution of RANO 2.0 in clinical trials, including the display of representative cases and in-depth discussion of challenging scenarios.",

author = "Ellingson, {Benjamin M} and Francesco Sanvito and Cloughesy, {Timothy F} and Huang, {Raymond Y} and Villanueva-Meyer, {Javier E} and Pope, {Whitney B} and Barboriak, {Daniel P} and Shankar, {Lalitha K} and Marion Smits and Kaufmann, {Timothy J} and Boxerman, {Jerrold L} and Michael Weller and Evanthia Galanis and Groot, {John de} and Gilbert, {Mark R} and Lassman, {Andrew B} and Shiroishi, {Mark S} and Ali Nabavizadeh and Minesh Mehta and Roger Stupp and Wolfgang Wick and Reardon, {David A} and Vogelbaum, {Michael A} and {van den Bent}, Martin and Chang, {Susan M} and Wen, {Patrick Y}",

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AU - Ellingson, Benjamin M

AU - Sanvito, Francesco

AU - Cloughesy, Timothy F

AU - Huang, Raymond Y

AU - Villanueva-Meyer, Javier E

AU - Pope, Whitney B

AU - Barboriak, Daniel P

AU - Shankar, Lalitha K

AU - Smits, Marion

AU - Kaufmann, Timothy J

AU - Boxerman, Jerrold L

AU - Weller, Michael

AU - Galanis, Evanthia

AU - Groot, John de

AU - Gilbert, Mark R

AU - Lassman, Andrew B

AU - Shiroishi, Mark S

AU - Nabavizadeh, Ali

AU - Mehta, Minesh

AU - Stupp, Roger

AU - Wick, Wolfgang

AU - Reardon, David A

AU - Vogelbaum, Michael A

AU - van den Bent, Martin

AU - Chang, Susan M

AU - Wen, Patrick Y

PY - 2024/8/5

Y1 - 2024/8/5

N2 - Radiographic assessment plays a crucial role in the management of patients with central nervous system (CNS) tumors, aiding in treatment planning and evaluation of therapeutic efficacy by quantifying response. Recently, an updated version of the Response Assessment in Neuro-Oncology (RANO) criteria (RANO 2.0) was developed to improve upon prior criteria and provide an updated, standardized framework for assessing treatment response in clinical trials for gliomas in adults. This article provides an overview of significant updates to the criteria including (1) the use of a unified set of criteria for high and low grade gliomas in adults; (2) the use of the post-radiotherapy MRI scan as the baseline for evaluation in newly diagnosed high-grade gliomas; (3) the option for the trial to mandate a confirmation scan to more reliably distinguish pseudoprogression from tumor progression; (4) the option of using volumetric tumor measurements; and (5) the removal of subjective non-enhancing tumor evaluations in predominantly enhancing gliomas (except for specific therapeutic modalities). Step-by-step pragmatic guidance is hereby provided for the neuroradiologist and imaging core lab involved in operationalization and technical execution of RANO 2.0 in clinical trials, including the display of representative cases and in-depth discussion of challenging scenarios.

AB - Radiographic assessment plays a crucial role in the management of patients with central nervous system (CNS) tumors, aiding in treatment planning and evaluation of therapeutic efficacy by quantifying response. Recently, an updated version of the Response Assessment in Neuro-Oncology (RANO) criteria (RANO 2.0) was developed to improve upon prior criteria and provide an updated, standardized framework for assessing treatment response in clinical trials for gliomas in adults. This article provides an overview of significant updates to the criteria including (1) the use of a unified set of criteria for high and low grade gliomas in adults; (2) the use of the post-radiotherapy MRI scan as the baseline for evaluation in newly diagnosed high-grade gliomas; (3) the option for the trial to mandate a confirmation scan to more reliably distinguish pseudoprogression from tumor progression; (4) the option of using volumetric tumor measurements; and (5) the removal of subjective non-enhancing tumor evaluations in predominantly enhancing gliomas (except for specific therapeutic modalities). Step-by-step pragmatic guidance is hereby provided for the neuroradiologist and imaging core lab involved in operationalization and technical execution of RANO 2.0 in clinical trials, including the display of representative cases and in-depth discussion of challenging scenarios.

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