Leptomeningeal metastases: A RANO proposal for response criteria

Marc Chamberlain, Larry Junck, Dieta Brandsma, Riccardo Soffietti, Roberta Rudà, Jeffrey Raizer, Willem Boogerd, Sophie Taillibert, Morris D. Groves, Emilie Le Rhun, Julie Walker, Martin Van Den Bent, Patrick Y. Wen, Kurt A. Jaeckle

Research output: Contribution to journalReview article

87 Scopus citations

Abstract

Leptomeningeal metastases (LM) currently lack standardization with respect to response assessment. A Response Assessment in Neuro-Oncology (RANO) working group with expertise in LM developed a consensus proposal for evaluating patients treated for this disease. Three basic elements in assessing response in LM are proposed: a standardized neurological examination, cerebral spinal fluid (CSF) cytology or flow cytometry, and radiographic evaluation. The group recommends that all patients enrolling in clinical trials undergo CSF analysis (cytology in all cancers; flow cytometry in hematologic cancers), complete contrast-enhanced neuraxis MRI, and in instances of planned intra-CSF therapy, radioisotope CSF flow studies. In conjunction with the RANO Neurological Assessment working group, a standardized instrument was created for assessing the neurological exam in patients with LM. Considering that most lesions in LM are nonmeasurable and that assessment of neuroimaging in LM is subjective, neuroimaging is graded as stable, progressive, or improved using a novel radiological LM response scorecard. Radiographic disease progression in isolation (ie, negative CSF cytology/flow cytometry and stable neurological assessment) would be defined as LM disease progression. The RANO LM working group has proposed a method of response evaluation for patients with LM that will require further testing, validation, and likely refinement with use.

Original languageEnglish (US)
Pages (from-to)484-492
Number of pages9
JournalNeuro-Oncology
Volume19
Issue number4
DOIs
StatePublished - Apr 1 2017

Keywords

  • CSF cytology/flow cytometry
  • Leptomeningeal metastasis
  • Neuraxis MRI
  • Neurological examination

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology
  • Cancer Research

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    Chamberlain, M., Junck, L., Brandsma, D., Soffietti, R., Rudà, R., Raizer, J., Boogerd, W., Taillibert, S., Groves, M. D., Le Rhun, E., Walker, J., Van Den Bent, M., Wen, P. Y., & Jaeckle, K. A. (2017). Leptomeningeal metastases: A RANO proposal for response criteria. Neuro-Oncology, 19(4), 484-492. https://doi.org/10.1093/neuonc/now183