Tensaouti Fatima, Khalifa Jonathan, Lusque Amélie, Plas Benjamin, Lotterie Jean Albert, Berry Isabelle, Laprie Anne, Cohen-Jonathan Moyal Elizabeth, Lubrano Vincent
ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.
Department of Radiation Oncology, Claudius Regaud Institute / Toulouse University Cancer Institute - Oncopole, Toulouse, France.
Neuroradiology. 2017 Oct;59(10):1013-1020. doi: 10.1007/s00234-017-1899-7. Epub 2017 Aug 25.
The purpose of the study was to evaluate Response Assessment in Neuro-Oncology (RANO) criteria in glioblastoma multiforme (GBM), with respect to the Macdonald criteria and changes in contrast-enhancement (CE) volume. Related variations in relative cerebral blood volume (rCBV) were investigated.
Forty-three patients diagnosed between 2006 and 2010 were included. All underwent surgical resection, followed by temozolomide-based chemoradiation. MR images were retrospectively reviewed. Times to progression (TTPs) according to RANO criteria, Macdonald criteria and increased CE volume (CE-3D) were compared, and the percentage change in the 75th percentile of rCBV (rCBV75) was evaluated.
After a median follow-up of 22.7 months, a total of 39 patients had progressed according to RANO criteria, 32 according to CE-3D, and 42 according to Macdonald. Median TTPs were 6.4, 9.3, and 6.6 months, respectively. Overall agreement was 79.07% between RANO and CE-3D and 93.02% between RANO and Macdonald. The mean percentage change in rCBV75 at RANO progression onset was over 73% in 87.5% of patients.
In conclusion, our findings suggest that CE-3D criterion is not yet suitable to assess progression in routine clinical practice. Indeed, the accurate threshold is still not well defined. To date, in our opinion, early detection of disease progression by RANO combined with advanced MRI imaging techniques like MRI perfusion and diffusion remains the best way to assess disease progression. Further investigations that would examine the impact of treatment modifications after progression determined by different criteria on overall survival would be of great value.
本研究旨在评估多形性胶质母细胞瘤（GBM）的神经肿瘤反应评估（RANO）标准，对比麦克唐纳标准以及对比增强（CE）体积的变化。研究了相对脑血容量（rCBV）的相关变化。
纳入2006年至2010年间确诊的43例患者。所有患者均接受了手术切除，随后进行了以替莫唑胺为基础的放化疗。对磁共振成像（MR）图像进行回顾性分析。比较了根据RANO标准、麦克唐纳标准和CE体积增加（CE-3D）得出的进展时间（TTP），并评估了rCBV第75百分位数（rCBV75）的百分比变化。
中位随访22.7个月后，根据RANO标准，共有39例患者病情进展；根据CE-3D标准，32例患者病情进展；根据麦克唐纳标准，42例患者病情进展。中位TTP分别为6.4个月、9.3个月和6.6个月。RANO与CE-3D之间的总体一致性为79.07%，RANO与麦克唐纳之间的总体一致性为93.02%。在RANO进展开始时，87.5%的患者rCBV75的平均百分比变化超过73%。
总之，我们的研究结果表明，CE-3D标准尚不适合在常规临床实践中评估病情进展。实际上，准确的阈值仍未明确界定。我们认为，迄今为止，通过RANO结合MRI灌注和扩散等先进MRI成像技术早期检测疾病进展仍是评估疾病进展的最佳方法。进一步研究不同标准确定的进展后治疗调整对总生存期的影响将具有重要价值。
