The RANO Leptomeningeal Metastasis Group proposal to assess response to treatment: lack of feasibility and clinical utility and a revised proposal

Emilie Le Rhun; Patrick Devos; Thomas Boulanger; Marion Smits; Dieta Brandsma; Roberta Rudà; Julia Furtner; Johann-Martin Hempel; Tjeerd Postma; Patrick Roth; Tom Snijders; Frank Winkler; Sebastian Winklhofer; Antonella Castellano; Elke Hattingen; Jaume Capellades; Thierry Gorlia; Martin van den Bent; Patrick Wen; Martin Bendszus; Michael Weller

doi:10.1093/neuonc/noz024

Journal articles

The RANO Leptomeningeal Metastasis Group proposal to assess response to treatment: lack of feasibility and clinical utility and a revised proposal

Emilie Le Rhun ^{1, 2, 3, 4} Patrick Devos ⁵ Thomas Boulanger ⁴ Marion Smits ⁶ Dieta Brandsma ⁷ Roberta Rudà ⁸ Julia Furtner ⁹ Johann-Martin Hempel ¹⁰ Tjeerd Postma ¹¹ Patrick Roth ^{1, 2} Tom Snijders ¹² Frank Winkler ^{13, 14} Sebastian Winklhofer ^{1, 2} Antonella Castellano ^{15, 16} Elke Hattingen ¹⁷ Jaume Capellades ¹⁸ Thierry Gorlia ¹⁹ Martin van den Bent ⁶ Patrick Wen ^{20, 21} Martin Bendszus ²² Michael Weller ^{1, 2}

1 University hospital of Zurich [Zurich]

2 UZH - University of Zürich [Zürich]

3 CHRU Lille - Centre Hospitalier Régional Universitaire [Lille]

4 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]

5 Université Lille 2 - Faculté de Médecine

6 Erasmus MC - Erasmus University Medical Center [Rotterdam]

7 NKI - Netherlands Cancer Institute

8 City of Health and Science University Hospital [Turin, Italy]

9 Medizinische Universität Wien = Medical University of Vienna

10 University of Tübingen

11 VU - Vrije Universiteit Amsterdam [Amsterdam]

12 University Medical Center [Utrecht]

13 Heidelberg University Hospital [Heidelberg]

14 DKTK - German Cancer Consortium [Heidelberg]

15 UniSR - Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie]

16 IRCCS Ospedale San Raffaele [Milan, Italy]

17 Goethe-University Frankfurt am Main

18 IMIM-Hospital del Mar

19 EORTC Headquarters [Brussels, Belgium]

20 Dana-Farber Cancer Institute [Boston]

21 Brigham and Women's Cancer center [Boston]

22 Universität Heidelberg [Heidelberg]

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 Leptomeningeal Assessment in Neuro-Oncology (LANO) scorecard, cerebrospinal MRIs 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 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 nonmeasurable (target) lesions and measures of change that allow assessment of response.

Keywords : assessment carcinomatous meningitis neoplastic response

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Journal articles

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Life Sciences [q-bio]

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https://www.hal.inserm.fr/inserm-02941514
Contributor : Michel Salzet <>
Submitted on : Thursday, September 17, 2020 - 10:05:00 AM
Last modification on : Wednesday, October 14, 2020 - 3:59:38 AM

The RANO Leptomeningeal Metastasis Group proposal to assess response to treatment: lack of feasibility and clinical utility and a revised proposal

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The RANO Leptomeningeal Metastasis Group proposal to assess response to treatment: lack of feasibility and clinical utility and a revised proposal

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