Evaluation of RANO response criteria compared to clinician evaluation in WHO grade III anaplastic astrocytoma: implications for clinical trial reporting and patterns of failure

Abstract

The utility of current response criteria has not been established in anaplastic astrocytoma (AA). We retrospectively reviewed MR images for 20 patients with AA and compared RANO-based approaches to clinician impression described as follow: (1) standard RANO-based criteria met by growth of or development of new enhancing lesion (RANO-C), (2) RANO criteria for progression based on significant FLAIR increase (RANO-F) and (3) clinical progression usually resulting in change of treatment (Clinical). Patterns of failure (POF) were analyzed utilizing all proposed progression MRIs fused with the patients’ radiotherapy treatment plan. With an overall median survival of 24.3 months, development of new enhancing lesion was the most common determinant of progression (70 % of patients). Median time to RANO-C, RANO-F and Clinical progression was 9.2, 9.2 and 11.76 months respectively. RANO-C and RANO-F preceded Clinical in 70 and 55 % of patients, respectively. In six patients (30 %) Clinical was concurrent with RANO-F; four of six also met RANO-C. POF for FLAIR component differed based on time point used to determine progression. FLAIR POF was more often marginal or distant when progression was defined clinically compared to either RANO-C or RANO-F criteria. Central POF based on FLAIR at Clinical determination of progression was associated with significantly poorer OS (9.8 vs. 34.4 months). Clinical progression occurs later than progression determined by RANO-based criteria. Evaluation of POF based on FLAIR signal abnormality at the time of clinical progression suggests central recurrences are associated with worse survival.

MRI Follow‐up of Astrocytoma: Automated Coregistration and Color‐Coding of FLAIR Sequences Improves Diagnostic Accuracy With Comparable Reading Time

“…Among others, MRI follow‐up of tumors of the central nervous system has become increasingly important to provide reliable endpoints for both existing and future therapies . Regarding longitudinal assessment of patients with astrocytoma, a frequent brain tumor of high clinical significance, assessment of FLAIR signal hyperintensity is important for follow‐up of low‐ and high‐grade tumors, since progression of nonenhancing tumor tissue is known to occur earlier than clinical progression . Changes in nonenhancing tumor burden as depicted in FLAIR or T 2 ‐weighted images can be subtle, making precise assessment of referring follow‐up MRI exams difficult and time‐consuming.…”

Recurrence patterns after maximal surgical resection and postoperative radiotherapy in anaplastic gliomas according to the new 2016 WHO classification

“…Patients were followed up with MRI 1 month after RT, every 3 months during the first 2 years, and every 6–12 months or when disease progression was suspected thereafter. Disease progression was defined as clinical progression based on an oncologist’s interpretation of imaging and clinical status, usually resulting in the change of treatment 22 . Pseudoprogression or radiation necrosis was differentiated with true progression by subsequent MRI, which showed resolution of contrast-enhanced lesions with edema without any change in therapy 23 .…”

Spatial patterns of glioblastoma failure related to contouring strategy of adjuvant radiotherapy (RTOG vs. EORTC target volumes approach): clinical trial introduction

“…1) [14]. Stejné dělení jsme použili i v naší předchozí studii hodnotící recidivy u anaplastických astrocytomů [15] a v představované studii GlioART.…”