The RANO Leptomeningeal Metastasis Group proposal to assess response to treatment: lack of feasibility and clinical utility and a revised proposal.
- Le Rhun E Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland.
- Devos P University Lille, France.
- Boulanger T Imaging Department, Oscar Lambret Center, Lille, France.
- Smits M Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands.
- Brandsma D Department of Neuro-oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands.
- Rudà R Department of Neuro-oncology, City of Health and Science and University of Turin, Turin, Italy.
- Furtner J Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
- Hempel JM Radiology Department, Department for Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany.
- Postma TJ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Amsterdam, Netherlands.
- Roth P Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland.
- Snijders TJ Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
- Winkler F Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.
- Winklhofer S Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Castellano A Neuroradiology Department, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Hattingen E Institute of Neuroradiology, University Hospital Frankfurt/Main, Frankfurt, Germany.
- Capellades J Neuroradiology Department, Hospital del Mar, Barcelona, Spain.
- Gorlia T EORTC Headquarters, Brussels, Belgium.
- Van den Bent M Brain Tumor Center at Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands.
- Wen PY Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA.
- Bendszus M Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.
- Weller M Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland.
- 2019-02-05
Published in:
- Neuro-oncology. - 2019
assessment
carcinomatous
meningitis
neoplastic
response
Adult
Aged
Clinical Trials as Topic
Combined Modality Therapy
Disease Progression
Feasibility Studies
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Meningeal Neoplasms
Middle Aged
Neoplasms
Neuroimaging
Patient Outcome Assessment
Survival Rate
Treatment Outcome
English
BACKGROUND
A scorecard to evaluate magnetic resonance imaging (MRI) findings during the course of leptomeningeal metastases (LM) has been proposed by the Response Assessment in Neuro-Oncology (RANO) group.
METHODS
To explore the feasibility of the Leptomeningeal Assessment in Neuro-Oncology (LANO) scorecard, cerebrospinal MRIs of 22 patients with LM from solid tumors were scored by 10 neuro-oncologists and 9 neuroradiologists at baseline and at follow-up after treatment. Raters were blinded for clinical data including treatment. Agreement between raters of single items was evaluated using a Krippendorff alpha coefficient. Agreement between numerical parameters such as scores for changes between baseline and follow-up and total scores was evaluated by determining the intraclass coefficient of correlation.
RESULTS
Most raters experienced problems with the instructions of the scorecard. No acceptable alpha concordance coefficient was obtained for the rating of single items at baseline or follow-up. The most concordant ratings were obtained for spinal nodules. The concordances were worst for brain linear leptomeningeal enhancement and cranial nerve enhancement. Discordance was less prominent among neuroradiologists than among neuro-oncologists. High variability was also observed for evaluating changes between baseline and follow-up and for total scores.
CONCLUSIONS
Assessing response of LM by MRI remains challenging. Central imaging review is therefore indispensable for clinical trials. Based on the present results, we propose a new, simplified scorecard that will require validation using a similar approach as pursued here. The main challenges are to define measurable versus nonmeasurable (target) lesions and measures of change that allow assessment of response.
A scorecard to evaluate magnetic resonance imaging (MRI) findings during the course of leptomeningeal metastases (LM) has been proposed by the Response Assessment in Neuro-Oncology (RANO) group.
METHODS
To explore the feasibility of the Leptomeningeal Assessment in Neuro-Oncology (LANO) scorecard, cerebrospinal MRIs of 22 patients with LM from solid tumors were scored by 10 neuro-oncologists and 9 neuroradiologists at baseline and at follow-up after treatment. Raters were blinded for clinical data including treatment. Agreement between raters of single items was evaluated using a Krippendorff alpha coefficient. Agreement between numerical parameters such as scores for changes between baseline and follow-up and total scores was evaluated by determining the intraclass coefficient of correlation.
RESULTS
Most raters experienced problems with the instructions of the scorecard. No acceptable alpha concordance coefficient was obtained for the rating of single items at baseline or follow-up. The most concordant ratings were obtained for spinal nodules. The concordances were worst for brain linear leptomeningeal enhancement and cranial nerve enhancement. Discordance was less prominent among neuroradiologists than among neuro-oncologists. High variability was also observed for evaluating changes between baseline and follow-up and for total scores.
CONCLUSIONS
Assessing response of LM by MRI remains challenging. Central imaging review is therefore indispensable for clinical trials. Based on the present results, we propose a new, simplified scorecard that will require validation using a similar approach as pursued here. The main challenges are to define measurable versus nonmeasurable (target) lesions and measures of change that allow assessment of response.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1093/neuonc/noz024
- PMID 30715514
- Persistent URL
- https://folia.unifr.ch/global/documents/193293
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