Macdonald criteria for glioblastoma

Macdonald criteria, published in 1990 , are used to assess response to first-line treatment of glioblastoma, but have been largely superseded by the RANO criteria which have become the mainstay of assessment.

For a general discussion see glioma treatment response assessment in clinical trials.

The Macdonald criteria, roughly similarly to other systems, divides response into 4 types of response based on imaging (MRI) and clinical features :

  • complete response
  • partial response
  • stable disease
  • progression
  • Measurement

    The measurements are obtained from axial post contrast T1 images. The maximal diameter is obtained, and then the second diameter is obtained at right angles to the first. The product of these measurements is then used for the purpose of comparison .

    One of the main problems with this system is that it does not address the presence of necrosis or surgical resection cavity.


    Complete response
    • imaging features
      • disappearance of all enhancing disease (measurable and non-measurable)
      • sustained for at least 4 weeks
      • no new lesions
    • clinical features
      • no corticosteroids
      • clinically stable or improved
    Partial response
    • imaging features
      • 50% or more decrease of all measurable enhancing lesions
      • sustained for at least 4 weeks
      • no new lesions
    • clinical features
      • stable or reduced corticosteroids
      • clinically stable or improved
    Stable disease
    • imaging features
      • does not qualify for complete response, partial response or progression
    • clinical features
      • clinically stable
    • imaging features
      • 25% of more increase in enhancing lesions
      • any new lesions
    • clinical features
      • clinical deterioration


    Although extremely useful, Macdonald criteria have been shown to have a number of weaknesses, many of which have been addressed in the Response Assessment in Neuro-Oncology Criteria (RANO), published in 2010. Some of these weaknesses include :

    • interobserver variability
    • nonenhancing tumor not assessed
      • lower grade component in secondary glioblastomas ignored
      • not applicable to low grade (non-enhancing) astrocytomas
    • difficulty measuring
      • irregularly shaped tumors
      • multifocal tumors
      • enhancing lesions in a surgical cavity or cystic tumor
      • recurrent disease in the setting of complete resection of enhancing component
    • effect of treatment