Table 1.
Summary of Key Response Criteria in Neuro-Oncology
| Response Criteria | Tumor Type | Measurable Disease | Nonmeasurable Disease | Imaging Criteria |
|---|---|---|---|---|
| MacDonald (1990) | Glioblastoma | Not defined | Not defined |
CR: disappearance of enhancing lesions and new lesions PR: ≥50% ↓ in enhancing lesions and no new lesions SD: <50% ↓ and <25% ↑ in enhancing lesions and no new lesions PD: ≥25% ↑ in enhancing lesions or appearance of any new lesion *CR and PR must be confirmed on ≥ 4-week follow-up |
| RANO (2010) | High-grade glioma | T1PG: – both diameters ≥ 10 mm – seen on ≥ 2 slices |
T1PG: – one diameter <10 mm – seen on <2 slices – cystic/necrotic tumor |
CR: disappearance of enhancing lesions (measurable/nonmeasurable), stable/improved T2/FLAIR lesions, and no new lesions PR: ≥50% ↓ in measurable enhancing lesions, no progression of nonmeasurable disease, stable/improved T2/FLAIR lesions, and no new lesions SD: <50% ↓ and <25% ↑ in enhancing lesions, stable T2/FLAIR lesions, and no new lesions PD: ≥25% ↑ in enhancing lesions, significant ↑ in T2/FLAIR lesions, or appearance of any new lesion *CR and PR must be confirmed on ≥4-week follow-up |
| RANO-LGG (2011) | Low-grade glioma | T2/FLAIR: – both diameters ≥10 mm – seen on ≥2 slices |
T2/FLAIR: – one diameter <10 mm – seen on <2 slices – cystic/necrotic tumor |
CR: disappearance of all T2/FLAIR lesions and no new or ↑ enhancement PR: ≥50% ↓ in T2/FLAIR lesions and no new or ↑ enhancement MinR: ≥25% but <50% ↓ in T2/FLAIR lesions and no new or ↑ enhancement SD: <25% ↓ and <25% ↑ in T2/FLAIR lesions and no new or ↑ enhancement PD: ≥25% ↑ in T2/FLAIR lesions or any new lesion *PR must be confirmed on ≥4-week follow-up |
| iRANO (2015) | High-grade glioma post immunotherapy | T1PG: – both diameters ≥10 mm – seen on ≥2 slices |
T1PG: – one diameter <10 mm – seen on <2 slices – cystic/necrotic tumor |
CR: disappearance of enhancing lesions (measurable/nonmeasurable), stable/improved T2/FLAIR lesions, and no new lesions PR: ≥50% ↓ in measurable enhancing lesions, no progression of nonmeasurable disease, stable/improved T2/FLAIR lesions, and no new lesions SD: <50% ↓ and <25% ↑ in enhancing lesions, stable T2/FLAIR lesions, and no new lesions PD: ≥25% ↑ in enhancing lesions, significant ↑ in T2/FLAIR lesions, or any new lesions >6 months after therapy or ≤6 months after therapy with confirmation on second follow-up scan after 3 months *CR and PR must be confirmed on ≥ 4-week follow-up |
| RANO-BM (2015) | Brain metastases | T1PG: – longest diameter ≥10 mm and perpendicular ≥5 mm – seen on ≥2 slices Target lesions: up to 5 measurable lesions selected based on largest size |
T1PG: – lesions <10 mm – nonreproducible borders – dural, bony, leptomeningeal metastases – cystic-only lesions All considered nontarget lesions |
CR: disappearance of target/nontarget lesions and no new lesions PR: ≥30% ↓ in sum of largest diameters of target lesions compared to baseline, stable/improved nontarget lesions, and no new lesions SD: <30% ↓ in target lesions compared to baseline and <20% ↑ compared to nadir, stable/improved nontarget lesions, and no new lesions PD: ≥20% ↑ compared to nadir, progression of existing enhancing or T2/FLAIR lesions, or presence of new lesion* *Patients not on immunotherapy |
| Modified RANO (2017) | Glioblastoma | T1PG: – both diameters ≥10 mm – seen on ≥2 slices |
T1PG: – one diameter <10 mm – seen on <2 slices – cystic/necrotic tumor |
CR: disappearance of enhancing lesions (measurable/nonmeasurable) compared to postradiation baseline PR: ≥50% ↓ in measurable enhancing lesions compared to postradiation baseline and SD/PR/CR compared to first follow-up SD: <50% ↓ and <25% ↑ in enhancing lesions compared to postradiation baseline or SD/PR/CR compared to smaller of nadir or PsP scan PD: ≥25% ↑ in enhancing lesions compared to postradiation baseline and confirmed on second scan or ≥25% ↑ in enhancing lesions compared to PsP scan |
| RAPNO-HGG (2020) | Pediatric HGG | T1PG or T2/FLAIR*: – both diameters ≥10 mm – seen on ≥2 slices – cystic lesion included if inseparable from solid *if no enhancement at baseline |
T1PG or T2/FLAIR: – one diameter <10 mm – seen on <2 slices – cystic lesion outside of solid lesion – diffuse leptomeningeal disease DWI: – areas of restricted diffusion |
CR: disappearance of measurable/nonmeasurable disease on T1PG and T2/FLAIR and complete resolution of areas of restricted diffusion on DWI PR: ≥50% ↓ in measurable disease and decreased areas of restricted diffusion on DWI MinR: ≥25% but <50% ↓ in measurable disease and decreased areas of restricted diffusion on DWI SD: <25% ↓ and <25% ↑ in measurable disease PD: ≥25% ↑ in measurable disease, clear increase in nonmeasurable disease, development of or increase in areas of restricted diffusion, or appearance of any new lesion |
| RAPNO-LGG (2020) | Pediatric LGG | T2/FLAIR*: – visible in 3 standard planes – both diameters ≥10 mm in all 3 planes – cystic lesion included if inseparable from solid *T1PG may be used for anterior optic gliomas, NF-1 tumors, or spinal tumors |
T2/FLAIR: – visible in <3 standard planes – one diameter <10 mm in any plane – cystic lesion outside of solid lesion – diffuse leptomeningeal disease |
CR: disappearance of measurable/nonmeasurable disease on T1PG and T2/FLAIR compared to baseline or best response MR: ≥75% ↓ in measurable disease but not enough for CR PR: ≥50% but <75% ↓ in measurable disease MinR: ≥25% but <50% ↓ in measurable disease SD: <25% ↓ and <25% ↑ in measurable disease PD: ≥25% ↑ in measurable disease *Response recommended to be confirmed on consecutive scan |
| BT-RADS (2018) | Any posttreatment tumor | N/A | N/A |
0: unable to categorize 1a: improvement due to decreasing tumor burden 1b: improvement due to medication effect 2: no change 3a: worsened imaging due to treatment effects 3b: worsened imaging due to mix of treatment effects and tumor burden 3c: worsened imaging due to increasing tumor burden 4: worsened imaging highly suspicious for tumor progression *Considers T2/FLAIR and T1PG changes in the context of treatment modality and time post treatment but does not incorporate measurements |
BM = brain metastases; BT-RADS = Brain Tumor Reporting and Data System; CR = complete response; DWI = diffusion-weighted imaging; HGG = high-grade glioma; LGG = low-grade glioma; MinR = minor response; MR = major response; PD = progressive disease; PR = partial response; PsP = pseudoprogression; RANO = response assessment in neuro-oncology; RAPNO = response assessment in pediatric neuro-oncology; SD = stable disease; T1PG = T1 post-gadolinium.