Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group.
Currently, the most widely used criteria for assessing response to therapy in high-grade gliomas are based on two-dimensional tumor measurements on computed tomography (CT) or magnetic resonance imaging (MRI), in conjunction with clinical assessment and corticosteroid dose (the Macdonald Criteria). It is increasingly apparent that there are significant limitations to these criteria, which only address the contrast-enhancing component of the tumor. For example, chemoradiotherapy for newly diagnosed glioblastomas results in transient increase in tumor enhancement (pseudoprogression) in 20% to 30% of patients, which is difficult to differentiate from true tumor progression. Antiangiogenic agents produce high radiographic response rates, as defined by a rapid decrease in contrast enhancement on CT/MRI that occurs within days of initiation of treatment and that is partly a result of reduced vascular permeability to contrast agents rather than a true antitumor effect. In addition, a subset of patients treated with antiangiogenic agents develop tumor recurrence characterized by an increase in the nonenhancing component depicted on T2-weighted/fluid-attenuated inversion recovery sequences. The recognition that contrast enhancement is nonspecific and may not always be a true surrogate of tumor response and the need to account for the nonenhancing component of the tumor mandate that new criteria be developed and validated to permit accurate assessment of the efficacy of novel therapies. The Response Assessment in Neuro-Oncology Working Group is an international effort to develop new standardized response criteria for clinical trials in brain tumors. In this proposal, we present the recommendations for updated response criteria for high-grade gliomas.
Wen
Patrick Y
PY
Center for Neuro-Oncology, Dana Farber/Brigham and Women's Cancer Center, SW430D, 44 Binney St, Boston, MA 02115, USA. pwen@partners.org
Macdonald
David R
DR
Reardon
David A
DA
Cloughesy
Timothy F
TF
Sorensen
A Gregory
AG
Galanis
Evanthia
E
Degroot
John
J
Wick
Wolfgang
W
Gilbert
Mark R
MR
Lassman
Andrew B
AB
Tsien
Christina
C
Mikkelsen
Tom
T
Wong
Eric T
ET
Chamberlain
Marc C
MC
Stupp
Roger
R
Lamborn
Kathleen R
KR
Vogelbaum
Michael A
MA
van den Bent
Martin J
MJ
Chang
Susan M
SM
D001932:Brain Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D002986:Clinical Trials as Topic; D003952:Diagnostic Imaging / Q000379:methods / Q000592:standards*; D005910:Glioma / Q000175:diagnosis* / Q000628:therapy*; D017408:Guidelines as Topic; D006801:Humans; D011379:Prognosis; D016896:Treatment Outcome