Having an accurate reproducible criteria for determining tumor

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					               Commentary on the “RANO” Criteria For High Grade Gliomas
                By Patrick Wen, M.D., Professor of Neurology, Harvard Medical School

Having an accurate, reproducible criteria for determining tumor response and progression
following therapy are critical for providing patients with optimal care and effectively evaluating
the efficacy of novel therapeutic agents. Since it’s introduction in 1990, the most widely used
criteria for determining treatment response in gliomas is two-dimensional measurement of
contrast enhancing tumor on neuroimaging studies, in conjunction with clinical assessment and
corticosteroid dose (“Macdonald Criteria”) (1). In recent years the limitations of these criteria
have become increasingly apparent. For example, it does not take into account the increasingly
common problem of “pseudoprogression” in patients receiving chemoradiotherapy, or the
problem of patients treated with anti-angiogenic agents who develop non-enhancing infiltrative
tumor recurrence (2). The Response Assessment in Neuro-Oncology (RANO) Working Group is
an international effort to develop new standardized consensus response criteria for determining
tumor response in patients with brain tumors. Recently, the RANO working group published
updated response criteria for high-grade gliomas in an attempt to address some of the
limitations of the “Macdonald Criteria. (3)” These criteria are a “work-in-progress.” As volumetric
imaging, and clinical, neuropsychologic and quality of life measures become better validated
and more widely applicable, it is hoped that these criteria will be eventually become
incorporated into future response criteria for brain tumors and improve our ability to determine
treatment efficacy.
1) Macdonald D, Cascino T, Schold SJ, et al: Resp onse criteria for phase II studies of supratentorial
malignant glioma. J Clin Oncol 8:1277-80, 1990

2) van den Bent MJ, Vogelbaum MA, Wen PY, et al: End point assessment in gliomas: novel treatments
limit usefulness of classical Macdonald's Criteria. J Clin Oncol 27:2905-8, 2009

3) Wen PY, Macdonald DR, Reardon DA, Cloughesy TM, Sorensen AG, Galanis E, DeGroot J, Wick W,
Gilbert MR, Lassman A, Tsien C, Mikkelsen T, Wong E T, Chamberlain M, Stupp R, Lamborn KL,
Vogelbaum M, van den Bent M, Chang SM. Updated Response Assessment Criteria For High -Grade
Gliomas: Response Assessment in Neuro-Oncology (RA NO) Working Group. J Clin Oncol 2010;