Souza, M. Jaeger, J. Descallar, E.-S. Koh ; SYDNEY/AU, LIVERPOOL/AU Neuroradiology brain, MR, Decision analysis, Cancer /ranzcr2014/R-0271

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1 Utility of the Response Assessment in Neuro-Oncology (RANO) imaging criteria in high grade glioma in routine clinical practice: Multi-reader concordance study Poster No.: R-027 Congress: 204 CSM Type: Scientific Exhibit Authors: Y. El Hgar, S. Pillay, R. Cuganesan, S. C. Hall, P. De 2 2 Souza, M. Jaeger, J. Descallar, E.-S. Koh ; SYDNEY/AU, 2 LIVERPOOL/AU Keywords: Neuroradiology brain, MR, Decision analysis, Cancer DOI: 0.594/ranzcr204/R-027 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply RANZCR/AIR/ACPSEM's endorsement, sponsorship or recommendation of the third party, information, product or service. RANZCR/AIR/ ACPSEM is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold RANZCR/AIR/ACPSEM harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies,.ppt slideshows,.doc documents and any other multimedia files are not available in the pdf version of presentations. Page of 9

2 Aim The 200 Response Assessment in Neuro-Oncology (RANO)criteria (RC) in high grade glioma, primarily designed for use in clinical trials, incorporated an improved approach to modern therapies, assessment of non-enhancing tumour, measurable and nonmeasurable disease. This study aimed to ) assess feasibility of RC application in everyday clinical practice; 2) determine whether RC use leads to greater concordance than reporting without application of response criteria; 3) determine practicality of RANO criteria use by registrar-level readers. Importantly, these criteria include an approach to the assessment of pseudoprogression, pseudoresponse, and the assessment of non-enhancing tumour component/s. Images for this section: Page 2 of 9

3 Fig. : Pseudoprogression Page 3 of 9

4 Fig. 2: Pseudoresponse Page 4 of 9

5 Methods and materials Serial MRI datasets, supplied with 3 monthly time points, were retrospectively collated from 0 newly diagnosed Glioblastoma patients from in South Western Sydney undergoing surgery and adjuvant chemo-radiation. Clinical status and corticosteroid usage to determine RC categories were supplied for each time-point and response categories assigned [complete response (CR), partial response (PR), progressive disease (PD) or stable disease (SD)]. Two neuro-radiologists (R,R2) and a radiology registrar (R3) independently scored each dataset according to RC, being blinded to R4 (actual reporting radiologist) reports. R4 assessments, completed with limited clinical information and no response criteria applied were categorized by an oncologist. Concordance between all four readers was documented. Images for this section: Fig. 3: Summary of mrano criteria Page 5 of 9

6 Fig. 4: Usage example Page 6 of 9

7 Results Of 22 MRI datasets reviewed, concordance between R and R2 was 8/22(82%) compared to only 4/22(64%) between R and R4 and 6/22(73%) between R2 and R4. Concordance between R3 (trainee) and R and R2 was 7/22(77%) and 9/22(86%) respectively, compared to 5/22(68%) between R3 and R4. An imaging response category could be assigned in 2/22(95%) of R4 reports versus 00% when RC were applied. Scenarios with multi-focal lesions showed lower reader concordance. Images for this section: Fig. 5: Results summary Page 7 of 9

8 Conclusion These findings support the feasibility of RANO criteria use in clinical practice, with high concordance exceeding that of routine reports. Concordance of registrar versus radiologist-level reading was moderately high, suggesting uptake by junior staff is feasible, especially with further training and increased familiarity with scoring of complex lesions. Personal information References.Louis D, Ohgaki, H, Wiestler, OD, Cavenee,WK. WHO Classification of Tumours ofthe Nervous System. Lyon IARC Press; Australian Cancer Incidence and Mortality (ACIM) books. Brain Cancer. [database on the Internet]. AIHW. 200 [cited 2 September 20]. Available from: SSWAHS Clinical Cancer Registry. Jan 2006 to Dec Malignant CNS tumourdata analysis. Sydney; 200 Contract No.: Document Number. 4.Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al.radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N EnglJ Med Mar 0;352(0): Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al.effects of radiotherapy with concomitant and adjuvant temozolomide versusradiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol May;0(5): Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancertreatment. Cancer. 98 Jan ;47(): Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, etal. Updated response assessment criteria for high-grade gliomas: responseassessment in neuro-oncology working group. J Clin Oncol. 200 Apr0;28(): Quant EC, Wen PY. Response assessment in neuro-oncology. Curr Oncol Rep.200 Feb;3():50-6. Page 8 of 9

9 9.Brandsma D, van den Bent MJ. Pseudoprogression and pseudoresponse in thetreatment of gliomas. Curr Opin Neurol Dec;22(6): Macdonald DR, Cascino TL, Schold SC, Jr., Cairncross JG. Response criteria forphase II studies of supratentorial malignant glioma. J Clin Oncol. 990Jul;8(7): van den Bent MJ, Vogelbaum MA, Wen PY, Macdonald DR, Chang SM. End pointassessment in gliomas: novel treatments limit usefulness of classical Macdonald'sCriteria. J Clin Oncol Jun 20;27(8): Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, etal. New guidelines to evaluate the response to treatment in solid tumors. EuropeanOrganization for Research and Treatment of Cancer, National Cancer Institute ofthe United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000Feb 2;92(3): Page 9 of 9