Response assessment in neuro-oncology (a report of the RANO group): assessment of outcome in trials of diffuse low-grade gliomas

Although low-grade gliomas (LGG) have a less aggressive course than do high-grade gliomas, the outcome of these tumours is ultimately fatal in most patients. Both the tumour and its treatment can cause disabling morbidity, particularly of cognitive functions. Because many patients present with seizu...

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Bibliographic Details
Published in:The lancet oncology Vol. 12; no. 6; pp. 583 - 593
Main Authors: van den Bent, MJ, Wefel, JS, Schiff, D, Taphoorn, MJB, Jaeckle, K, Junck, L, Armstrong, T, Choucair, A, Waldman, AD, Gorlia, T, Chamberlain, M, Baumert, BG, Vogelbaum, MA, Macdonald, DR, Reardon, DA, Wen, PY, Chang, SM, Jacobs, AH
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01.06.2011
Elsevier Limited
Subjects:
Brain cancer
Brain Neoplasms - mortality
Brain Neoplasms - pathology
Brain Neoplasms - therapy
Clinical trials
Clinical Trials as Topic
Cognition & reasoning
Cognitive ability
Disease Progression
Glioma - mortality
Glioma - pathology
Glioma - therapy
Hematology, Oncology and Palliative Medicine
Humans
Magnetic Resonance Imaging
Medical prognosis
Oncology
Patients
Positron-Emission Tomography
Quality of life
Radiation therapy
Treatment Outcome
Tumors
ISSN:1470-2045, 1474-5488, 1474-5488
Online Access:Get full text
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Summary:Although low-grade gliomas (LGG) have a less aggressive course than do high-grade gliomas, the outcome of these tumours is ultimately fatal in most patients. Both the tumour and its treatment can cause disabling morbidity, particularly of cognitive functions. Because many patients present with seizures only, with no other signs and symptoms, maintenance of quality of life and function constitutes a particular challenge in LGG. The slow growth pattern of most LGG, and the rare radiological true responses despite a favourable clinical response to treatment, interferes with the use of progression-free survival as the primary endpoint in trials. Overall survival as an endpoint brings logistical challenges, and is sensitive to other non-investigational salvage therapies. Clinical trials for LGG need to consider other measures of patient benefit such as cognition, symptom burden, and seizure activity, to establish whether improved survival is reflected in prolonged wellbeing. This Review investigates clinical and imaging endpoints in trials of LGG, and provides response assessment in neuro-oncology (RANO) criteria for non-enhancing tumours. Additionally, other measures for patients with brain tumours that assess outcome are described. Similar considerations are relevant for trials of high-grade gliomas, although for these tumours survival is shorter and survival endpoints generally have more value than they do for LGG.
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ISSN:1470-2045
1474-5488
1474-5488
DOI:10.1016/S1470-2045(11)70057-2