Practical Needs in Assessing Response to Therapy in Operated Brain High Grade Glioma According to Response Assessment in Neuro-Oncology Criteria

Abstract

Background: Tumors known as gliomas begin in the brain or spine's glial cells and might spread throughout the body.  An effort was made to improve tumor response evaluation and end point selection through the Response Assessment in Neuro-Oncology (RANO) working group.

Objective: To standardize the assessment method and results reporting by applying MRI-RANO criteria in detecting glioma response to surgical treatment.

Patients and Methods: This was a prospective cohort study included 12 patients (4 males and 8 females) whose mean age was 53.6 ± 15.1years. Included patients are those who were operated and pathologically proved as brain glioma grade IV (GBM). They underwent post-operative MRI within 48 hours and are available for follow up MRI after 3 months. Imaging modalities applied in both MRI exams were conventional magnetic resonance imaging, MRI diffusion weighted images, and contrast imaging. RANO criteria were applied.

Results: According to RANO criteria, none of the lesions had pseudo response or pseudo progression. However, two thirds (66.7%) had progressive disease and one third (33.3%) had complete response. There was statistically significant association between MRI findings 3 months postoperative and RANO criteria as patients with compete response had statistically significant decrease on measurable solid components, diffusion restriction, post contrast enhancement and all lesions had grade I edema with no mass effect or midline shift compared to patients with progressive disease. 4 cases that showed complete response category had fulfilled all the RANO criteria, while 8 cases with category progressive disease had fulfilled more than one of the described RANO criteria.

Conclusion: RANO criteria are an effective tool to be used in interpretation of MRI for follow-up of surgically operated glioma patients to detect their response.