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| Neuro-oncology. 2019 Jan 23. pii: 5306141. doi: 10.1093/neuonc/noz024 |
| The RANO Leptomeningeal Metastasis Group proposal to assess response to treatment: lack of feasibility and clinical utility, and a revised proposal. |
| Le Rhun E1, Devos P2, Boulanger T3, Smits M4, Brandsma D5, Rudà R6, Furtner J7, Hempel JM8, Postma TJ9, Roth P10, Snijders TJ11, Winkler F12, Winklerhofer S13, Castellano A14, Hattingen E15, Capellades J16, Gorlia T17, van den Bent M18, Wen PY19, Bendzus M20, Weller M21 |
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Abstract BACKGROUND: A scorecard to evaluate magnetic resonance imaging (MRI) findings during the course of leptomeningeal metastases (LM) has been proposed by the Response Assessment in Neuro-Oncology (RANO) group. METHODS: To explore the feasibility of the LANO scorecard, cerebrospinal MRI of 22 patients with LM from solid tumors were scored by 10 neuro-oncologists and 9 neuroradiologists at baseline and at follow-up after treatment. Raters were blinded for clinical data including treatment. Agreement between raters for the evaluation of single items was evaluated using a Krippendorff alpha coefficient. Agreement between numerical parameters such as scores for changes between baseline and follow-up and total scores was evaluated by determining the intraclass coefficient of correlation. RESULTS: Most raters experienced problems with the instructions of the scorecard. No acceptable alpha concordance coefficient was obtained for the rating of single items at baseline or follow-up. The most concordant ratings were obtained for spinal nodules. The concordances were worst for brain linear leptomeningeal enhancement and cranial nerve enhancement. Discordance was less prominent among neuroradiologists than among neuro-oncologists. High variability was also observed for evaluating changes between baseline and follow-up and for total scores. CONCLUSIONS: Assessing response of LM by MRI remains challenging. Central imaging review is therefore indispensable for clinical trials. Based on the present results, we propose a new, simplified scorecard that will require validation using a similar approach as pursued here. The main challenges are to define measurable versus non-measurable (target) lesions and measures of change that allow assessment of response. |
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Publikations ID: 30715514 Quelle: öffnen |
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