RANO criteria for glioblastoma

Response Assessment in Neuro-Oncology Criteria (RANO), published in 2010 1, are used to assess response to first-line treatment of glioblastoma, (as well as lower grade astrocytoma3) and have largely superseded the older Macdonald criteria (which only dealt with GBM) 2.

For a general discussion see glioma treatment response assessment in clinical trials

The RANO 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 RANO criteria were, at least in part, developed to address the issues faced when measuring some lesions on Macdonald criteria, particularly:

  • lesions with central necrosis
  • T2 component

As such lesions are defined as "measurable" and "non-measurable" 1

Measurable lesions

A measurable lesions is measured as follows:

  • either CT or MRI
  • contrast enhancing
  • clearly defined margins
  • visible on two or more axial slices
    • preferably <5 mm thick with 0mm skip
  • maximal diameter and second perpendicular measurement
    • at least 10 mm in size (if slice thickness <5 mm) 
    • 2 times slice thickness (if slice thickness >5 mm)
    • From ref 1: "In the event there are interslice gaps, this also needs to be considered in determining the size of measurable lesions at baseline." - [needs clarification]
  • do not measure cystic cavity
Non-measurable lesions

Non-measurable lesions are generally those that do not meet the criteria above. Additionally, and worthy of specific mention, is a cystic / necrotic tumour, or one with a surgical cavity. In such cases only a solid peripheral nodular component should be measured, provided it fulfills the above 'measurable' criteria. 

Again, it is not difficult to think of numerous examples where defining a 'nodule' is difficult. It is therefore crucial that the base line scan is available as well as the axes of initial measurement in assessing response. 

The measurements are obtained from axial post contrast T1 images. The maximal diameter is obtained, and then the second diameter is obtained at right angles to the first. The product of these measurements is then used for the purpose of comparison 1-2.

Criteria

Complete response
  • imaging features
    • disappearance of all enhancing disease (measurable and non-measurable)
    • sustained for at least 4 weeks
    • stable or improved non enhancing FLAIR/T2 lesions
    • no new lesions
  • clinical features
    • no corticosteroids (physiological replacement doses allowed)
    • clinically stable or improved
Partial response
  • imaging features
    • 50% or more decrease of all measurable enhancing lesions
    • sustained for at least 4 weeks
    • no progression of non-measurable disease
    • stable or improved non enhancing FLAIR/T2 lesions
    • no new lesions
  • clinical features
    • stable or reduced corticosteroids (compared to baseline) 
    • clinically stable or improved
Stable disease
  • imaging features
    • does not qualify for complete response, partial response or progression
    • stable non-enhancing FLAIR/T2 lesions
  • clinical features
    • stable or reduced corticosteroids (compared to baseline) 
    • clinically stable
Progression
  • imaging features
    • 25% of more increase in enhancing lesions despite stable or increasing steroid dose
    • increase (significant) in non-enhancing T2/FLAIR lesions, not attributable to other non-tumour causes
    • any new lesions
  • clinical features
    • clinical deterioration (not attributable to other non-tumour causes and not due to steroid decrease)
Astrocytic tumour
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Article information

rID: 29155
Synonyms or Alternate Spellings:
  • Response Assessment in Neuro-Oncology Criteria (RANO)
  • Response Assessment in Neuro-Oncology Criteria
  • RANO criteria

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