title: Response assessment in recurrent glioblastoma treated with irinotecan-bevacizumab: comparative analysis of the Macdonald, RECIST, RANO, and RECIST + F criteria.
abstract: Traditionally, the most widely used criteria for response assessment in glioblastoma have been Macdonald and the Response Evaluation Criteria In Solid Tumors (RECIST). Recently, new criteria addressing contrast enhancement and fluid-attenuated inversion recovery (FLAIR)/T2 hyperintensity have been defined (the Response Assessment in Neuro-Oncology criteria) to better evaluate the effect of antiangiogenic therapy. Whether FLAIR/T2 imaging could also be helpful to refine RECIST criteria remains unresolved. This study proposed the RECIST + F criteria and compared the 4 methods (Macdonald, RECIST, RANO, and RECIST + F) to determine their agreement in identifying response and progression of recurrent glioblastomas to irinotecan-bevacizumab. Patients with recurrent glioblastoma treated with second-line irinotecan-bevacizumab were eligible. Clinical status, corticosteroid dose, and 1-dimensional and 2-dimensional measurements of tumor contrast enhancement and FLAIR hyperintensity were retrospectively assessed. Response and progression were determined according to each set of criteria. Seventy-eight patients were included. Response rates ranged from 34.2% with RECIST + F to 44.7% with Macdonald criteria. Agreement among the 4 methods in determining response and type of progression was high (kappa statistic > 0.75). One-third of patients exhibited nonenhancing progression with stable or improved contrast enhancement. Median progression-free survival was predicted by RECIST, at 13.6 weeks; RECIST + F, 12.3; Macdonald, 12.7; and RANO, 11.7 (P = .840). Intra- and interobserver correlations were high for both contrast enhancement and FLAIR hyperintensity measurements. There was a strong concordance among the different methods in determining response and progression to irinotecan-bevacizumab. Criteria integrating FLAIR hyperintensity tended, however, to reduce response rates and progression-free survival compared with criteria considering only contrast enhancement. The 1-dimensional approach appeared to be as valid as the 2-dimensional approach.
authors.affiliation: Service de Neurologie 2, Division Mazarin, Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière, UMR S975, Paris, France.
authors.forename: Jaime
authors.initials: J
authors.lastname: Gállego Pérez-Larraya
authors.forename: Marion
authors.initials: M
authors.lastname: Lahutte
authors.forename: Gregorio
authors.initials: G
authors.lastname: Petrirena
authors.forename: Germán
authors.initials: G
authors.lastname: Reyes-Botero
authors.forename: Alberto
authors.initials: A
authors.lastname: González-Aguilar
authors.forename: Caroline
authors.initials: C
authors.lastname: Houillier
authors.forename: Rémy
authors.initials: R
authors.lastname: Guillevin
authors.forename: Marc
authors.initials: M
authors.lastname: Sanson
authors.forename: Khê
authors.initials: K
authors.lastname: Hoang-Xuan
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Delattre
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab; D001932:Brain Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D003952:Diagnostic Imaging / Q000592:standards*; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D017063:Outcome Assessment, Health Care / Q000592:standards*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D000077146:Irinotecan; D002166:Camptothecin