title: Leptomeningeal metastases: a RANO proposal for response criteria.
abstract: Leptomeningeal metastases (LM) currently lack standardization with respect to response assessment. A Response Assessment in Neuro-Oncology (RANO) working group with expertise in LM developed a consensus proposal for evaluating patients treated for this disease. Three basic elements in assessing response in LM are proposed: a standardized neurological examination, cerebral spinal fluid (CSF) cytology or flow cytometry, and radiographic evaluation. The group recommends that all patients enrolling in clinical trials undergo CSF analysis (cytology in all cancers; flow cytometry in hematologic cancers), complete contrast-enhanced neuraxis MRI, and in instances of planned intra-CSF therapy, radioisotope CSF flow studies. In conjunction with the RANO Neurological Assessment working group, a standardized instrument was created for assessing the neurological exam in patients with LM. Considering that most lesions in LM are nonmeasurable and that assessment of neuroimaging in LM is subjective, neuroimaging is graded as stable, progressive, or improved using a novel radiological LM response scorecard. Radiographic disease progression in isolation (ie, negative CSF cytology/flow cytometry and stable neurological assessment) would be defined as LM disease progression. The RANO LM working group has proposed a method of response evaluation for patients with LM that will require further testing, validation, and likely refinement with use.
authors.affiliation: Department of Neurology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Chamberlain
authors.affiliation: Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Junck
authors.affiliation: Department of Neuro-Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.
authors.forename: Dieta
authors.initials: D
authors.lastname: Brandsma
authors.affiliation: Department of Neuro-Oncology, University Hospital, Torino, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Soffietti
authors.affiliation: Department of Neuro-Oncology, University Hospital, Torino, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rudà
authors.affiliation: Department of Neurology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Raizer
authors.affiliation: Department of Neuro-Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Boogerd
authors.affiliation: Departments of Neuro-Oncology Marazin and Radiation Oncology, Pitie-Salpetrieree Hospital and University Pierre et Marie Curie, Paris VI, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Taillibert
authors.affiliation: Austin Brain Tumor Center, Texas Oncology/US Oncology Research, Austin, Texas, USA.
authors.forename: Morris D
authors.initials: MD
authors.lastname: Groves
authors.affiliation: Department of Neuro-Oncology, University Hospital, Department of Neurology, Oscar Lambret Center, Lille, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Le Rhun
authors.affiliation: Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Walker
authors.affiliation: Department of Neuro-oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, Netherlands.
authors.forename: Martin
authors.initials: M
authors.lastname: van den Bent
authors.affiliation: Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA.
authors.forename: Patrick Y
authors.initials: PY
authors.lastname: Wen
authors.affiliation: Departments of Neurology and Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA.
authors.forename: Kurt A
authors.initials: KA
authors.lastname: Jaeckle
mesh_terms: D002986:Clinical Trials as Topic / Q000592:standards; D018450:Disease Progression; D006801:Humans; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome
keywords: CSF cytology/flow cytometry; leptomeningeal metastasis; neurological examination; neuraxis MRI