Response Assessment in Neuro-Oncology criteria, contrast enhancement and perfusion MRI for assessing progression in glioblastoma

Tensaouti, F.; Khalifa, J.; Lusque, Amélie; Plas, Benjamin; Lotterie, Jean Albert; Berry, Isabelle; Laprie, Anne; Moyal, Elizabeth Cohen-Jonathan; Lubrano, V.

doi:10.1007/s00234-017-1899-7

Cited by 18 publications

(11 citation statements)

References 33 publications

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“…Izquierdo et al (35) have reported that mean tumor diameter of low-grade glioma progressively decreased in most patients (94.4%) with a median slope of -5.7 mm/year (range=-14.84 to -0.85 mm/year) and for a median duration of 23 months after TMZ treatment. In GBM, median time to progression according to the Response Assessment in Neuro-Oncology (RANO) criteria was 6.4 months (36). These results suggested that our patients had refractory tumors against TMZ.…”

Section: Discussionmentioning

confidence: 70%

Seizures and Tumor Progression in Glioma Patients with Uncontrollable Epilepsy Treated with Perampanel

et al. 2018

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Section: Discussionmentioning

confidence: 70%

Seizures and Tumor Progression in Glioma Patients with Uncontrollable Epilepsy Treated with Perampanel

et al. 2018

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“…Nevertheless, experts seem to be required for non-enhancing tumor segmentation in non-glioblastomas on MRI at progression. MRIs at progression of non-glioblastomas are difficult to interpret because these suffer from artefacts from radiation therapy that cannot be discerned from disease progression ( Tensaouti et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

“…For glioblastomas, the spatial overlap agreement between raters was high on preoperative MRI, which is not surprising due to the unambiguous distinction of contrast enhancing tumor to non-enhancing surrounding tissue. At progression the contrast becomes more ambiguous due to treatment effects such as pseudo-progression or radiation induced necrosis ( Tensaouti et al, 2017 ). The contrast becomes even more ambiguous on postoperative MRI with small fragmented residual tumor in the presence of surgical artefacts.…”

Section: Discussionmentioning

confidence: 99%

Inter-rater agreement in glioma segmentations on longitudinal MRI

Visser

Müller

Duijn

et al. 2019

NeuroImage: Clinical

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Background Tumor segmentation of glioma on MRI is a technique to monitor, quantify and report disease progression. Manual MRI segmentation is the gold standard but very labor intensive. At present the quality of this gold standard is not known for different stages of the disease, and prior work has mainly focused on treatment-naive glioblastoma. In this paper we studied the inter-rater agreement of manual MRI segmentation of glioblastoma and WHO grade II-III glioma for novices and experts at three stages of disease. We also studied the impact of inter-observer variation on extent of resection and growth rate. Methods In 20 patients with WHO grade IV glioblastoma and 20 patients with WHO grade II-III glioma (defined as non-glioblastoma) both the enhancing and non-enhancing tumor elements were segmented on MRI, using specialized software, by four novices and four experts before surgery, after surgery and at time of tumor progression. We used the generalized conformity index (GCI) and the intra-class correlation coefficient (ICC) of tumor volume as main outcome measures for inter-rater agreement. Results For glioblastoma, segmentations by experts and novices were comparable. The inter-rater agreement of enhancing tumor elements was excellent before surgery (GCI 0.79, ICC 0.99) poor after surgery (GCI 0.32, ICC 0.92), and good at progression (GCI 0.65, ICC 0.91). For non-glioblastoma, the inter-rater agreement was generally higher between experts than between novices. The inter-rater agreement was excellent between experts before surgery (GCI 0.77, ICC 0.92), was reasonable after surgery (GCI 0.48, ICC 0.84), and good at progression (GCI 0.60, ICC 0.80). The inter-rater agreement was good between novices before surgery (GCI 0.66, ICC 0.73), was poor after surgery (GCI 0.33, ICC 0.55), and poor at progression (GCI 0.36, ICC 0.73). Further analysis showed that the lower inter-rater agreement of segmentation on postoperative MRI could only partly be explained by the smaller volumes and fragmentation of residual tumor. The median interquartile range of extent of resection between raters was 8.3% and of growth rate was 0.22 mm/year. Conclusion Manual tumor segmentations on MRI have reasonable agreement for use in spatial and volumetric analysis. Agreement in spatial overlap is of concern with segmentation after surgery for glioblastoma and with segmentation of non-glioblastoma by non-experts.

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“…While this article focuses on reporting results from the HERBY trial as performed, the newer proposed assessments can also be applied retrospectively to the HERBY imaging data, which may better characterize the imaging assessment. In addition to these modified and more quantitative metrics derivable from structural MR imaging, other quantitative metrics can be extracted from the multimodal imaging, 12,[18][19][20][21][22][23] building on the qualitative radiologic assessment performed here, 5 to inform on their value in pediatric response assessment. This will form the basis for ongoing evaluation of data from the HERBY study.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Implementation of the Response Assessment in Neuro-Oncology Criteria in the HERBY Trial of Pediatric Patients with Newly Diagnosed High-Grade Gliomas

Rodriguez¹,

Chambers

Warmuth‐Metz³

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: HERBY was a Phase II multicenter trial setup to establish the efficacy and safety of adding bevacizumab to radiation therapy and temozolomide in pediatric patients with newly diagnosed non-brain stem high-grade gliomas. This study evaluates the implementation of the radiologic aspects of HERBY. MATERIALS AND METHODS: We analyzed multimodal imaging compliance rates and scan quality for participating sites, adjudication rates and reading times for the central review process, the influence of different Response Assessment in Neuro-Oncology criteria in the final response, the incidence of pseudoprogression, and the benefit of incorporating multimodal imaging into the decision process. RESULTS: Multimodal imaging compliance rates were the following: diffusion, 82%; perfusion, 60%; and spectroscopy, 48%. Neuroradiologists' responses differed for 50% of scans, requiring adjudication, with a total average reading time per patient of approximately 3 hours. Pseudoprogression occurred in 10/116 (9%) cases, 8 in the radiation therapy/temozolomide arm and 2 in the bevacizumab arm (P Ͻ .01). Increased target enhancing lesion diameter was a reason for progression in 8/86 cases (9.3%) but never the only radiologic or clinical reason. Event-free survival was predicted earlier in 5/86 (5.8%) patients by multimodal imaging (diffusion, n ϭ 4; perfusion, n ϭ 1). CONCLUSIONS: The addition of multimodal imaging to the response criteria modified the assessment in a small number of cases, determining progression earlier than structural imaging alone. Increased target lesion diameter, accounting for a large proportion of reading time, was never the only reason to designate disease progression. ABBREVIATIONS: BEV ϭ bevacizumab; CRRC ϭ Centralized Radiologic Review Committee; EFS ϭ event-free survival; HGG ϭ high-grade glioma; MM ϭ multimodal; RANO ϭ Response Assessment in Neuro-Oncology; RT ϭ radiotherapy; TMZ ϭ temolozomide T he recent Avastin in Glioblastoma (AVAglio) clinical trial investigated the use of bevacizumab (BEV) plus radiation therapy (RT) and temozolomide (TMZ) compared with a placebo plus RT-TMZ in adult patients with newly diagnosed glioblastoma. 1 This was subsequently investigated in a pediatric patient population. The Study of Bevacizumab (Avastin) in Combination with Temozolomide and Radiotherapy in Paediatric and Adolescent Participants with High-Grade Glioma (HERBY) (BO25041; clinicaltrials.gov NCT01390948) was a Phase II, open-label, randomized, multicenter, comparator study set up to establish the efficacy and safety of the addition of BEV to RT and TMZ in patients between 3 and 18 years of age with newly diagnosed non-brain stem high-grade glioma (HGG). 2 The radiologic aspects of the HERBY trial were expanded compared with AVAglio in a number of aspects. In HERBY, the

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Response Assessment in Neuro-Oncology criteria, contrast enhancement and perfusion MRI for assessing progression in glioblastoma

Cited by 18 publications

References 33 publications

Seizures and Tumor Progression in Glioma Patients with Uncontrollable Epilepsy Treated with Perampanel

Seizures and Tumor Progression in Glioma Patients with Uncontrollable Epilepsy Treated with Perampanel

Inter-rater agreement in glioma segmentations on longitudinal MRI

Evaluation of the Implementation of the Response Assessment in Neuro-Oncology Criteria in the HERBY Trial of Pediatric Patients with Newly Diagnosed High-Grade Gliomas

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