title: Recommendations for imaging tumor response in neurofibromatosis clinical trials.
abstract: OBJECTIVE
  Neurofibromatosis (NF)-related benign tumors such as plexiform neurofibromas (PN) and vestibular schwannomas (VS) can cause substantial morbidity. Clinical trials directed at these tumors have become available. Due to differences in disease manifestations and the natural history of NF-related tumors, response criteria used for solid cancers (1-dimensional/RECIST [Response Evaluation Criteria in Solid Tumors] and bidimensional/World Health Organization) have limited applicability. No standardized response criteria for benign NF tumors exist. The goal of the Tumor Measurement Working Group of the REiNS (Response Evaluation in Neurofibromatosis and Schwannomatosis) committee is to propose consensus guidelines for the evaluation of imaging response in clinical trials for NF tumors.
  
  
  METHODS
  Currently used imaging endpoints, designs of NF clinical trials, and knowledge of the natural history of NF-related tumors, in particular PN and VS, were reviewed. Consensus recommendations for response evaluation for future studies were developed based on this review and the expertise of group members.
  
  
  RESULTS
  MRI with volumetric analysis is recommended to sensitively and reproducibly evaluate changes in tumor size in clinical trials. Volumetric analysis requires adherence to specific imaging recommendations. A 20% volume change was chosen to indicate a decrease or increase in tumor size. Use of these criteria in future trials will enable meaningful comparison of results across studies.
  
  
  CONCLUSIONS
  The proposed imaging response evaluation guidelines, along with validated clinical outcome measures, will maximize the ability to identify potentially active agents for patients with NF and benign tumors.
authors.affiliation: From the Pediatric Oncology Branch (E.D., B.C.W.), National Cancer Institute, Bethesda, MD; Department of Neurology (S.L.A.-H.), The Children's Hospital at Westmead, Sydney, Australia; Department of Medical Genetics (D. B.-V.), Mayo Clinic, Rochester, MN; Neurosurgical Service (F.G.B.), Department of Radiology (G.J.H.), and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston, MA; Department of Neuroradiology (S.C.), King's College Hospital, London, UK; Department of Genetic Medicine (D.G.E.), MAHSC, St Mary's Hospital, Manchester, UK; Division of Oncology (M.J.F.) and Department of Radiology (D.J.), The Children's Hospital of Philadelphia; Department of Pediatrics (M.J.F.), The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Neurosurgery (S.G.), Hôpital Beaujon, Clichy, France; Division of Pediatric Hematology/Oncology and NYU Cancer Institute (M.A.K.), NYU Langone Medical Center, New York, NY; Department of Genetics (B.R.K.), University of Alabama at Birmingham, Birmingham, AL; Department of Neurology (V.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (T.Y.P.), Boston Children's Hospital, Boston, MA; and Department of Pediatrics (K.R., C.-S.S.), Riley Hospital for Children, Indianapolis, IN.
authors.forename: Eva
authors.initials: E
authors.lastname: Dombi
authors.forename: Simone L
authors.initials: SL
authors.lastname: Ardern-Holmes
authors.forename: Dusica
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authors.lastname: Babovic-Vuksanovic
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authors.initials: DG
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authors.lastname: Goutagny
authors.forename: Gordon J
authors.initials: GJ
authors.lastname: Harris
authors.forename: Diego
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authors.lastname: Jaramillo
authors.forename: Matthias A
authors.initials: MA
authors.lastname: Karajannis
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Korf
authors.forename: Victor
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authors.lastname: Mautner
authors.forename: Scott R
authors.initials: SR
authors.lastname: Plotkin
authors.forename: Tina Y
authors.initials: TY
authors.lastname: Poussaint
authors.forename: Kent
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authors.lastname: Robertson
authors.forename: Chie-Schin
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authors.lastname: Shih
authors.forename: Brigitte C
authors.initials: BC
authors.lastname: Widemann
mesh_terms: D002986:Clinical Trials as Topic / Q000379:methods / Q000592:standards*; D003952:Diagnostic Imaging / Q000379:methods* / Q000592:standards; D006801:Humans; D018318:Neurofibroma, Plexiform / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D017253:Neurofibromatoses / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D009464:Neuroma, Acoustic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D059016:Tumor Microenvironment