AVAglio criteria for glioblastoma

The AVAglio criteria were developed to assess response to first-line treatment of glioblastoma, treated with radiotherapy and temozolomide with or without bevacizumab 1-2. These were adapted from the older Macdonald criteria, but have since been superseded by they RANO criteria (2010) 1

The AVAglio criteria, roughly similarly to other systems, divides response into 4 types of response based on imaging (MRI) and clinical features 1-2

  1. complete response
  2. partial response
  3. stable disease
  4. progression

Measurement

The AVAglio criteria were, at least in part, developed to address the issues faced when measuring some lesions on Macdonald criteria including T2 non-enhancing components. 

Criteria

Complete response
  • imaging features
    • disappearance of all enhancing disease (measurable and non-measurable)
    • sustained for at least 4 weeks
    • no worsening of non-index lesions
    • no new lesions
  • clinical features
    • no corticosteroids (physiological replacement doses allowed)
    • clinically stable or improved neurological symptoms
Partial response
  • imaging features
    • 50% or more decrease of all measurable enhancing lesions
    • sustained for at least 4 weeks
    • no progression of non-index lesions
    • no new lesions
  • clinical features
    • stable or reduced corticosteroids 
    • clinically stable or improved neurologic symptoms
Stable disease
  • imaging features
    • does not qualify for complete response, partial response or progression
  • clinical features
    • clinically stable or improved neurologic symptoms
    • NB: steroid dose alone does not affect "stable disease"
Progression
  • imaging features
    • 25% of more increase in index lesions
    • unequivocal progression of existing non-index lesions
    • any new lesions
  • clinical features
    • clinical neurologic deterioration (only if steroid dose stable or increased)
Astrocytic tumour
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