PET-based response assessment criteria for diffuse gliomas (PET RANO 1.0): a report of the RANO group.

in The Lancet. Oncology by Nathalie L Albert, Norbert Galldiks, Benjamin M Ellingson, Martin J van den Bent, Susan M Chang, Francesco Cicone, John de Groot, Eng-Siew Koh, Ian Law, Emilie Le Rhun, Maximilian J Mair, Giuseppe Minniti, Roberta Rudà, Andrew M Scott, Susan C Short, Marion Smits, Bogdana Suchorska, Nelleke Tolboom, Tatjana Traub-Weidinger, Joerg-Christian Tonn, Antoine Verger, Michael Weller, Patrick Y Wen, Matthias Preusser

TLDR

  • This study proposes standardized criteria for response assessment based on amino acid PET imaging in clinical trials for diffuse gliomas, aiming to improve accuracy and reliability of treatment monitoring.

Abstract

Response Assessment in Neuro-Oncology (RANO) response criteria have been established and were updated in 2023 for MRI-based response evaluation of diffuse gliomas in clinical trials. In addition, PET-based imaging with amino acid tracers is increasingly considered for disease monitoring in both clinical practice and clinical trials. So far, a standardised framework defining timepoints for baseline and follow-up investigations and response evaluation criteria for PET imaging of diffuse gliomas has not been established. Therefore, in this Policy Review, we propose a set of criteria for response assessment based on amino acid PET imaging in clinical trials enrolling participants with diffuse gliomas as defined in the 2021 WHO classification of tumours of the central nervous system. These proposed PET RANO criteria provide a conceptual framework that facilitates the structured implementation of PET imaging into clinical research and, ultimately, clinical routine. To this end, the PET RANO 1.0 criteria are intended to encourage specific investigations of amino acid PET imaging of gliomas.

Overview

  • The study proposes standardized criteria for response assessment based on amino acid PET imaging in clinical trials for patients with diffuse gliomas.
  • The criteria aim to facilitate the implementation of PET imaging into clinical research and practice, building upon the 2023 RANO response criteria for MRI-based response evaluation.
  • The proposed PET RANO 1.0 criteria were designed to provide a conceptual framework for the structured implementation of PET imaging into clinical trials and routine practice.

Comparative Analysis & Findings

  • A lack of standardized framework defining timepoints for baseline and follow-up investigations and response evaluation criteria for PET imaging of diffuse gliomas was identified.
  • The proposed PET RANO 1.0 criteria provide a structured approach for response assessment based on amino acid PET imaging in clinical trials.
  • The criteria are intended to promote specific investigations of amino acid PET imaging of gliomas, enabling more accurate and reproducible assessment of treatment response.

Implications and Future Directions

  • The proposed PET RANO 1.0 criteria are expected to increase the accuracy and reliability of response assessment in clinical trials for patients with diffuse gliomas.
  • The criteria may lead to improved patient outcomes through more effective treatment strategies and monitoring.
  • Future research could focus on refining the PET RANO 1.0 criteria and exploring their applicability to other types of cancer and imaging modalities.
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