Glioma treatment response assessment in clinical trials

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Glioma treatment response assessment in clinical trials has undergone numerous revisions with a number of criteria having been developed over the years. This has been necessary as a result of a number of factors:

  • improved understanding of tumor biology (e.g. appreciating the importance of non-enhancing tumor)
  • the realization that existing criteria are flawed (e.g. measuring necrotic tumors)
  • changes in imaging parameters

    • Although superficially most share similarities, as the saying goes, the devil is in the details.

    Currently, the most widely used system to assess first line treatment response in glioblastomas (and lower grade diffuse astrocytomas) are the Response Assessment in Neuro-Oncology Criteria (RANO), which were published in 2010 .

    To address the challenges of emerging novel immunotherapy for high-grade glioma immunotherapy response assessment for neuro-oncology (iRANO) criteria have been developed in 2015 .

    Previous systems

    • Levin criteria
    • World Health Organization (WHO) oncology response criteria
    • Macdonald criteria (1990) 
      • very influential and widely used with a number of serious limitation which became evident over the two decades after their publication
    • Response Evaluation Criteria in Solid Tumors (RECIST)
      • not specific to gliomas
    • AVAglio criteria (2009)
      • modified Macdonald criteria
    • RANO criteria (2010) 
      • currently the most widely used system, representing a refinement of the Macdonald criteria
    • iRANO criteria (2015)
      • for tumors treated with immunotherapy
    • modified RANO criteria (2017) 
    • RTOG 0825 criteria