RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults

Wen, Patrick Y.; van den Bent, Martin; Youssef, Gilbert; Cloughesy, Timothy F.; Ellingson, Benjamin M.; Weller, Michael; Galanis, Evanthia; Barboriak, Daniel P.; de Groot, John; Gilbert, Mark R.; Huang, Raymond; Lassman, Andrew B.; Mehta, Minesh; Molinaro, Annette M.; Preusser, Matthias; Rahman, Rifaquat; Shankar, Lalitha K.; Stupp, Roger; Villanueva-Meyer, Javier E.; Wick, Wolfgang; Macdonald, David R.; Reardon, David A.; Vogelbaum, Michael A.; Chang, Susan M.

doi:10.1200/jco.23.01059

Cited by 99 publications

(28 citation statements)

References 45 publications

(84 reference statements)

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“…Xi et al ( 2023 ) compared the GTR rates between 61 cases of FGS and 51 cases of non-FGS, which were 45.9% and 19.6%, respectively. The authors attributed the lower GTR rates in the above two studies than others to the utilization of the RANO criteria to define EOR (Wen et al 2023 ). A meta-analysis by Smith et al ( 2021 ) enrolled 21 studies regarding intraoperative fluorescence, including 11 single arm studies without control group and 10 high quality case-controlled studies, which was integrated for the analysis.…”

Section: Discussionmentioning

confidence: 98%

Fluorescein-guided surgery in high-grade gliomas: focusing on the eloquent and deep-seated areas

Xiao,

Li,

Wang

et al. 2024

J Cancer Res Clin Oncol

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Purpose The vital function of eloquent and deep brain areas necessitates precise treatment for tumors located in these regions. Fluorescein-guided surgery (FGS) has been widely used for high-grade gliomas (HGGs) resection. Nevertheless, the safety and efficacy of utilizing this technique for resecting brain tumors located in eloquent and deep-seated areas remain uncertain. This study aims to assess the safety and extent of resection of HGGs in these challenging tumors with fluorescein and explore its impact on patient survival. Methods A retrospective analysis was conducted on the clinical and radiological data of 67 consecutive patients with eloquent or deep-seated HGGs who underwent surgery between January 2020 and June 2023. Lacroix functional location grade was used to determine the eloquence of the tumors. The comparison between the fluorescence-guided surgery group (FGS, n = 32) and the conventional white-light microscopic surgery group (non-FGS, n = 35) included assessments of extent of resection (EOR), rates of gross total resection (GTR, 100%) and near-total resection (NTR, 99 to 98%), postoperative Neurologic Assessment in Neuro-Oncology (NANO) scores, overall survival (OS), and progression-free survival (PFS), to evaluate the safety and efficacy of fluorescein-guided technology in tumor resection at these specific locations. Results Baseline of demographics, lesion location, and pathology showed no significant difference between the two groups. GTR of the FGS group was higher than the non-FGS group (84.4% vs. 60.0%, OR 3.60, 95% CI 1.18–10.28, p < 0.05). The FGS group also showed higher GTR + NTR (EOR ≥ 98%) than the non-FGS group (93.8% vs. 65.7%, OR 7.83, 95% CI 1.86–36.85, p < 0.01). 87.0% of eloquent tumors (Lacroix grade III) in the FGS group achieved GTR + NTR, compared to 52.2% of control group (OR 6.11, 95% CI 1.50–22.78, p < 0.05). For deep-seated tumors, the rate of GTR + NTR in the two groups were 91.7% and 53.3%, respectively (OR 9.62, 95% CI 1.05–116.50, p < 0.05). No significant difference of the preoperative NANO score of the two groups was found. The postoperative NANO score of the FGS group was significantly lower than the non-FGS group (2.56 ± 1.29 vs. 3.43 ± 1.63, p < 0.05). Median OS of the FGS group was 4.2 months longer than the non-FGS group despite no statistical difference (18.2 months vs. 14.0 months, HR 0.63, 95% CI 0.36–1.11, p = 0.112), while PSF was found significantly longer in FGS patients than those of the non-FGS group (11.2 months vs. 7.7 months, HR 0.59, 95% CI 0.35–0.99, p < 0.05). Conclusion Sodium fluorescein-guided surgery for high-grade gliomas in eloquent and deep-seated brain regions enables more extensive resection while preserving neurologic function and improve patient survival.

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Section: Discussionmentioning

confidence: 98%

Fluorescein-guided surgery in high-grade gliomas: focusing on the eloquent and deep-seated areas

Xiao,

Li,

Wang

et al. 2024

J Cancer Res Clin Oncol

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“…Dedicated neuro-oncologists and radiotherapists were involved in treatment and follow-up of our patients. Tumor progression was diagnosed using the RANO criteria 27 .…”

Section: Neuro-oncological Treatment and Follow-upmentioning

confidence: 99%

Beyond resection boundaries for glioblastoma patients: is “primum non nocere” a key factor for prognosis?

Cristofori,

Rui,

Graziano

et al. 2024

Preprint

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Purpose Maximal resection has a pivotal role in the treatment of glioblastoma, prolonging both progression free survival (PFS) and overall survival (OS). Increasingly, very few studies analyze the delicate equilibrium between maximal resection, clinical outcome and prognosis. The aim of this study is to determine the impact of neurological impairment on PFS, OS and access to adjuvant therapies. Methods this retrospective study encompassed patients operated for a GBM at Fondazione IRCCS San Gerardo dei Tintori Monza (IT), from 2015 to 2023. Histological diagnosis was performed according to 2021 WHO 2021. Patients were more than 18 years old, with pre and postoperative MRI, who underwent surgery and adjuvant treatments at our institution. Results A total of 231 patients fulfilled the criteria. Patients with improvement or complete regression of preoperative deficit had higher rate of access to adjuvant therapies (p = 0.023). Patients with hemiparesis at discharge had the worst PFS (median 4.60 months), Vs patients with aphasia, (6.60 months) Vs 9.67 for patients with normal examination (p < 0.0001). Median OS was 19.30 months for patients with hemianopia Vs 7.73 for patients with hemiparesis and 14.03 months with aphasia (p < 0.0001). Conclusion Hemianopia has no impact on patient’s prognosis, while hemiparesis and aphasia at discharge worsen both PFS and OS and prolong time-to-treatment. The “primum non nocere” principle must be the main policy: extend the resection at the cost of a minor deficit, preserve motor and language functions, encourage home cares for the most vulnerable patients.

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“…The Response Assessment in Neuro-Oncology (RANO) Working Group published revised response criteria for gliomas in 2023 [21]. These RANO 2.0 criteria recommend a standard set of criteria for both high-and low-grade gliomas to be used for all trials regardless of the treatment modalities being evaluated.…”

Section: Rano 20mentioning

confidence: 99%

Speeding Up and Improving Image Quality in Glioblastoma MRI Protocol by Deep Learning Image Reconstruction

Gohla,

Hauser,

Bombach

et al. 2024

Cancers

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A fully diagnostic MRI glioma protocol is key to monitoring therapy assessment but is time-consuming and especially challenging in critically ill and uncooperative patients. Artificial intelligence demonstrated promise in reducing scan time and improving image quality simultaneously. The purpose of this study was to investigate the diagnostic performance, the impact on acquisition acceleration, and the image quality of a deep learning optimized glioma protocol of the brain. Thirty-three patients with histologically confirmed glioblastoma underwent standardized brain tumor imaging according to the glioma consensus recommendations on a 3-Tesla MRI scanner. Conventional and deep learning-reconstructed (DLR) fluid-attenuated inversion recovery, and T2- and T1-weighted contrast-enhanced Turbo spin echo images with an improved in-plane resolution, i.e., super-resolution, were acquired. Two experienced neuroradiologists independently evaluated the image datasets for subjective image quality, diagnostic confidence, tumor conspicuity, noise levels, artifacts, and sharpness. In addition, the tumor volume was measured in the image datasets according to Response Assessment in Neuro-Oncology (RANO) 2.0, as well as compared between both imaging techniques, and various clinical–pathological parameters were determined. The average time saving of DLR sequences was 30% per MRI sequence. Simultaneously, DLR sequences showed superior overall image quality (all p < 0.001), improved tumor conspicuity and image sharpness (all p < 0.001, respectively), and less image noise (all p < 0.001), while maintaining diagnostic confidence (all p > 0.05), compared to conventional images. Regarding RANO 2.0, the volume of non-enhancing non-target lesions (p = 0.963), enhancing target lesions (p = 0.993), and enhancing non-target lesions (p = 0.951) did not differ between reconstruction types. The feasibility of the deep learning-optimized glioma protocol was demonstrated with a 30% reduction in acquisition time on average and an increased in-plane resolution. The evaluated DLR sequences improved subjective image quality and maintained diagnostic accuracy in tumor detection and tumor classification according to RANO 2.0.

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RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults

Cited by 99 publications

References 45 publications

Fluorescein-guided surgery in high-grade gliomas: focusing on the eloquent and deep-seated areas

Fluorescein-guided surgery in high-grade gliomas: focusing on the eloquent and deep-seated areas

Beyond resection boundaries for glioblastoma patients: is “primum non nocere” a key factor for prognosis?

Speeding Up and Improving Image Quality in Glioblastoma MRI Protocol by Deep Learning Image Reconstruction

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