RANO-Kriterien bei höhergradigen hirneigenen Tumoren

Zusammenfassung

In der Behandlung höhergradiger hirneigener Tumoren muss man verlässlich beurteilen können, wie die Tumoren auf die Therapie ansprechen. Dies gilt für den klinischen Alltag und klinische Studien gleichermaßen. Die klassische Beurteilung des Therapieansprechens anhand der Macdonald-Kriterien wird den komplexer werdenden neuroonkologischen Therapien mit oft antiangiogen wirkenden Substanzen jedoch häufig nicht gerecht. Beispielsweise blieben für die korrekte radiologische Beurteilung wichtige Phänomene wie Pseudoprogression und T2-Progress bislang unberücksichtigt. Die Arbeitsgruppe „Response Assessment in Neuro-Oncology (RANO)“ hat daher neue Kriterien (RANO-Kriterien) erarbeitet, die sowohl radiologische Besonderheiten neuer Therapieregime berücksichtigen als auch eine Standardisierung der Auswertung klinischer Studien ermöglichen soll. Im folgenden Artikel wird ein Überblick über die wichtigsten Neuerungen gegeben, welche für den Radiologen bei der Befundung unmittelbar eine Rolle spielen.

Abstract

Reliable treatment response assessment is crucial for the treatment of high-grade glioma within clinical studies as well as for daily clinical decision making. The traditionally used Macdonald-Criteria often do not meet the needs of more complex oncologic therapies, especially antangiogenic therapies. For example, important radiologic phenomena such as pseudoprogression and T2-progress were not considered in Macdonald-Criteria. Therefore the working group for Response Assessment in Neuro-Oncology (RANO) has established new criteria that take into account the specifics of new therapy regimes and new standards fort the response assessment within clinical trials. In this article the most important innovations caused by the RANO-Criteria that play a direct role for the daily radiological work are summarized.

Keywords

Malignant glioma - Macdonald-Criteria - RANO-Criteria - pseudoprogression - pseudoresponse

• Literatur

• 1 Wen PY, Kesari S. Malignant gliomas in adults. N Engl J Med 2008; 359: 492-507
• 2 Macdonald DR et al. Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 1990; 8: 1277-1280
• 3 Wen PY et al. Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 2010; 28: 1963-1972
• 4 Henegar MM, Moran CJ, Silbergeld DL. Early postoperative magnetic resonance imaging following nonneoplastic cortical resection. J Neurosurg 1996; 84: 174-179
• 5 Kumar AJ et al. Malignant gliomas: MR imaging spectrum of radiation therapy- and chemotherapy-induced necrosis of the brain after treatment. Radiology 2000; 217: 377-384
• 6 Finn MA et al. Transient postictal MRI changes in patients with brain tumors may mimic disease progression. Surg Neurol 2007; 67: 246-250 ; discussion 250
• 7 Ulmer S et al. Clinical and radiographic features of peritumoral infarction following resection of glioblastoma. Neurology 2006; 67: 1668-1670
• 8 Stupp R et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005; 352: 987-996
• 9 Brandsma D, van den Bent MJ. Pseudoprogression and pseudoresponse in the treatment of gliomas. Curr Opin Neurol 2009; 22: 633-638
• 10 Chamberlain MC et al. Early necrosis following concurrent Temodar and radiotherapy in patients with glioblastoma. J Neurooncol 2007; 82: 81-83
• 11 Taal W et al. Incidence of early pseudo-progression in a cohort of malignant glioma patients treated with chemoirradiation with temozolomide. Cancer 2008; 113: 405-410
• 12 Brandes AA et al. MGMT promoter methylation status can predict the incidence and outcome of pseudoprogression after concomitant radiochemotherapy in newly diagnosed glioblastoma patients. J Clin Oncol 2008; 26: 2192-2197
• 13 Bendszus M, Platten M. Neuroradiological response criteria for malignant gliomas. Nervenarzt 2010; 81: 950-955
• 14 Young RJ et al. Potential utility of conventional MRI signs in diagnosing pseudoprogression in glioblastoma. Neurology 2011; 76: 1918-1924
• 15 Hygino da Cruz Jr LC et al. Pseudoprogression and pseudoresponse: imaging challenges in the assessment of posttreatment glioma. AJNR Am J Neuroradiol 2011; 32: 1978-1985
• 16 Tsien C et al. Parametric response map as an imaging biomarker to distinguish progression from pseudoprogression in high-grade glioma. J Clin Oncol 2010; 28: 2293-2299
• 17 Galban CJ et al. Prospective analysis of parametric response map-derived MRI biomarkers: identification of early and distinct glioma response patterns not predicted by standard radiographic assessment. Clin Cancer Res 2011; 17: 4751-4760
• 18 Yang I, Aghi MK. New advances that enable identification of glioblastoma recurrence. Nat Rev Clin Oncol 2009; 6: 648-657
• 19 Radbruch A et al. Comment to: Parametric response map as an imaging biomarker to distinguish progression from pseudoprogression in high-grade glioma: pitfalls in perfusion MRI in brain tumors. J Clin Oncol 2010; 28: 2293-2299
• 20 Batchelor TT et al. AZD2171, a pan-VEGF receptor tyrosine kinase inhibitor, normalizes tumor vasculature and alleviates edema in glioblastoma patients. Cancer Cell 2007; 11: 83-95
• 21 Vredenburgh JJ et al. Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol 2007; 25: 4722-4729
• 22 Friedman HS et al. Bevacizumab alone and in combination with irinotecan in recurrent glioblastoma. J Clin Oncol 2009; 27: 4733-4740
• 23 Norden AD et al. An exploratory survival analysis of anti-angiogenic therapy for recurrent malignant glioma. J Neurooncol 2009; 92: 149-155
• 24 Norden AD et al. Bevacizumab for recurrent malignant gliomas: efficacy, toxicity, and patterns of recurrence. Neurology 2008; 70: 779-787
• 25 Bergers G, Hanahan D. Modes of resistance to anti-angiogenic therapy. Nat Rev Cancer 2008; 8: 592-603
• 26 Radbruch A et al. Relevance of T2 signal changes in the assessment of progression of glioblastoma according to the Response Assessment in Neurooncology criteria. Neuro Oncol 2012; 14: 222-229
• 27 Pope WB, Hessel C. Response assessment in neuro-oncology criteria: implementation challenges in multicenter neuro-oncology trials. AJNR Am J Neuroradiol 2011; 32: 794-797
• 28 Pope WB, Young JR, Ellingson BM. Advances in MRI assessment of gliomas and response to anti-VEGF therapy. Curr Neurol Neurosci Rep 2011; 11: 336-344
• 29 Di Costanzo A et al. Proton MR spectroscopy of cerebral gliomas at 3 T: spatial heterogeneity, and tumour grade and extent. Eur Radiol 2008; 18: 1727-1735