Response assessment in neuro-oncology (a report of the RANO group): assessment of outcome in trials of diffuse low-grade gliomas - 06/08/11

Doi : 10.1016/S1470-2045(11)70057-2

MJ van den Bent, ProfMD ^a,^⁎ , JS Wefel, PhD ^b, D Schiff, MD ^c, MJB Taphoorn, ProfMD ^d,^e, K Jaeckle, MD ^f, L Junck, MD ^g, T Armstrong, PhD ^b,^h, A Choucair, MD ⁱ, AD Waldman, PhD ^j, T Gorlia, MSc ^k, M Chamberlain, MD ^l, BG Baumert, MD ^m, MA Vogelbaum, MD ⁿ, DR Macdonald, MD ^o, DA Reardon, MD ^p, PY Wen, ProfMD ^q, SM Chang, ProfMD ^r, AH Jacobs, ProfMD ^s,^t

^a Neuro-Oncology Unit, Daniel den Hoed Cancer Center/Erasmus University Hospital Rotterdam, Rotterdam, Netherlands

^b Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX, USA

^c Neuro-Oncology Center, Departments of Neurology, Neurological Surgery, and Medicine, University of Virginia, Charlottesville, VA, USA

^d Department of Neurology, MC Haaglanden, the Hague, Netherlands

^e Vrije Universiteit Medical Centre, Amsterdam, Netherlands

^f Mayo Clinic Florida, Jacksonville, FL, USA

^g University of Michigan Department of Neurology, Ann Arbor, MI, USA

^h Department of Integrative Nursing, University of Texas Health Science Center School of Nursing, Houston, TX, USA

ⁱ Neuro Oncology Service Intermountain Healthcare, Murray, UT, USA

^j Imperial College, London, UK

^k EORTC Headquarters, Brussels, Belgium

^l University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

^m Department of Radiation-Oncology (MAASTRO), GROW (School for Oncology and Developmental Biology), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands

ⁿ Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA

^o Department of Oncology (Medical Oncology), London Regional Cancer Program, University of Western Ontario, London, ON, Canada

^p Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA

^q Center for Neuro-Oncology, Dana Farber/Brigham and Women’s Cancer Center and Division of Neurology, Brigham and Women’s Hospital, Boston, MA, USA

^r Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, CA, USA

^s European Institute for Molecular Imaging (EIMI), University of Munster (WWU), Munster, Germany

^t Laboratory for Gene Therapy and Molecular Imaging, Max Planck-Institute for Neurological Research, Cologne, Germany

^* Correspondence to: Prof M J van den Bent, Neuro-Oncology Unit, Daniel den Hoed Cancer Center/Erasmus University Hospital, PO Box 5201, 3008AE Rotterdam, Netherlands

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.

Le texte complet de cet article est disponible en PDF.

Plan

Introduction

Traditional primary endpoints in phase 3 LGG trials

Imaging: diagnosis of progression and response

Physiological and quantitative MRI

PET

Imaging follow-up and response assessment in clinical trials

Extent of resection

Definition of clinical benefit and clinical progression or neurological deterioration

Conclusions: combined approach

Search strategy and selection criteria

Export

Vol 12 - N° 6

P. 583-593 - juin 2011 Retour au numéro

Article précédent

Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial
Willem van Gijn, Corrie AM Marijnen, Iris D Nagtegaal, Elma Meershoek-Klein Kranenbarg, Hein Putter, Theo Wiggers, Harm JT Rutten, Lars Påhlman, Bengt Glimelius, Cornelis JH van de Velde, for the Dutch Colorectal Cancer Group

| Article suivant

KRAS, BRAF, PIK3CA, and PTEN mutations: implications for targeted therapies in metastatic colorectal cancer
Wendy De Roock, Veerle De Vriendt, Nicola Normanno, Fortunato Ciardiello, Sabine Tejpar

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

connectez-vous ou créez un compte

Response assessment in neuro-oncology (a report of the RANO group): assessment of outcome in trials of diffuse low-grade gliomas - 06/08/11

Summary

Plan

Export citations

Fichier

Contenu

Accès rapides

Mon compte

Aide & support

Plateformes Elsevier Masson

Déclaration CNIL