title: Application of novel response/progression measures for surgically delivered therapies for gliomas: Response Assessment in Neuro-Oncology (RANO) Working Group.
abstract: BACKGROUND
  The Response Assessment in Neuro-Oncology (RANO) Working Group is an international, multidisciplinary effort to develop new standardized response criteria for clinical trials in brain tumors. The RANO group identified knowledge gaps relating to the definitions of tumor response and progression after the use of surgical or surgically based treatments.
  
  
  OBJECTIVE
  To outline a proposal for new response and progression criteria for the assessment of the effects of surgery and surgically delivered therapies for patients with gliomas.
  
  
  METHODS
  The Surgery Working Group of RANO identified surgically related end-point evaluation problems that were not addressed in the original Macdonald criteria, performed an extensive literature review, and used a consensus-building process to develop recommendations for how to address these issues in the setting of clinical trials.
  
  
  RESULTS
  Recommendations were formulated for surgically related issues, including imaging changes associated with surgical resection or surgically mediated adjuvant local therapies, the determination of progression in the setting where all enhancing tumor has been removed, and how new enhancement should be interpreted in the setting where local therapies that are known to produce nonspecific enhancement have been used. Additionally, the terminology used to describe the completeness of surgical resections has been recognized to be inconsistently applied to enhancing vs nonenhancing tumors, and a new set of descriptors is proposed.
  
  
  CONCLUSIONS
  The RANO process is intended to produce end-point criteria for clinical trials that take into account the effects of prior and ongoing therapies. The RANO criteria will continue to evolve as new therapies and technologies are introduced into clinical trial and/or practice.
authors: Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio 44195, USA. vogelbm@ccf.org
authors: Michael A
authors: MA
authors: Vogelbaum
authors: Sarah
authors: S
authors: Jost
authors: Manish K
authors: MK
authors: Aghi
authors: Amy B
authors: AB
authors: Heimberger
authors: John H
authors: JH
authors: Sampson
authors: Patrick Y
authors: PY
authors: Wen
authors: David R
authors: DR
authors: Macdonald
authors: Martin J
authors: MJ
authors: Van den Bent
authors: Susan M
authors: SM
authors: Chang