Comparison of 2D (RANO) and volumetric methods for assessment of recurrent glioblastoma treated with bevacizumab-a report from the BELOB trial

Renske Gahrmann, Martin van den Bent, Bronno van der Holt, Rene Michel Vernhout, Walter Taal, Maaike Vos, Jan Cees de Groot, Laurens Victor Beerepoot, Jan Buter, Zwenneke Hendrieke Flach, Monique Hanse, Bas Jasperse, Marion Smits*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

14 Citations (Scopus)

Abstract

Background. The current method for assessing progressive disease (PD) in glioblastoma is according to the Response Assessment in Neuro-Oncology (RANO) criteria. Bevacizumab-treated patients may show pseudo-response on postcontrast T1-weighted (T1w) MRI, and a more infiltrative non-enhancing growth pattern on T2w/fluid attenuated inversion recovery (FLAIR) images. We investigated whether the RANO criteria remain the method of choice for assessing bevacizumab-treated recurrent glioblastoma when compared with various volumetric methods.

Methods. Patients with assessable MRI data from the BELOB trial (n = 148) were included. Patients were treated with bevacizumab, lomustine, or both. At first and second radiological follow-up (6 and 12 wk), PD was determined using the 2D RANO criteria and various volumetric methods based on enhancing tumor only and enhancing plus non-enhancing tumor. Differences in overall survival (OS) between PD and non-PD patients were assessed with the log-rank test and a Cox model. Hazard ratios (HRs) and their 95% CIs were determined.

Results. For all patients together, all methods (except subtraction of non-enhancing from enhancing volume at first follow-up) showed significant differences in OS between PD and non-PD patients (P <.001). The largest risk increase for death in case of PD at both first and second follow-up was found with the RANO criteria: HR = 2.81 (95% CI, 1.92-4.10) and HR = 2.80 (95% CI, 1.75-4.49), respectively. In the bevacizumab-treated patients, all methods assessed showed significant differences in OS between PD and non-PD patients. There were no significant differences between methods.

Conclusions. In the first 12 weeks, volumetric methods did not provide significant improvement over the RANO criteria as a posttreatment prognostic marker.

Original languageEnglish
Pages (from-to)853-861
Number of pages9
JournalNeuro-Oncology
Volume19
Issue number6
DOIs
Publication statusPublished - Jun-2017

Keywords

  • bevacizumab
  • RANO
  • recurrent glioblastoma
  • volumetry
  • HIGH-GRADE GLIOMAS
  • SINGLE-AGENT BEVACIZUMAB
  • RESPONSE ASSESSMENT
  • TUMOR SIZE
  • MALIGNANT GLIOMAS
  • PLUS IRINOTECAN
  • PHASE-II
  • SURVIVAL
  • CRITERIA
  • PATTERNS

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