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    Response Assessment in Neuro-Oncology (RANO)

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    Rini Andriani
    This document summarizes response assessment criteria for central and peripheral nervous system tumors, specifically the Response Assessment in Neuro-Oncology (RANO) criteria. It discusses imaging requirements, definitions of response assessments including complete response, partial response, stable disease, and progressive disease. It also covers special considerations like pseudo progression and pseudo response that can mimic tumor progression or response. Several case examples are presented to demonstrate application of the RANO criteria.

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    Response Assessment in Neuro-Oncology (RANO)

    Uploaded by

    Rini Andriani
    52 views31 pages
    This document summarizes response assessment criteria for central and peripheral nervous system tumors, specifically the Response Assessment in Neuro-Oncology (RANO) criteria. It discusses imaging requirements, definitions of response assessments including complete response, partial response, stable disease, and progressive disease. It also covers special considerations like pseudo progression and pseudo response that can mimic tumor progression or response. Several case examples are presented to demonstrate application of the RANO criteria.

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    Rano

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    This document summarizes response assessment criteria for central and peripheral nervous system tumors, specifically the Response Assessment in Neuro-Oncology (RANO) criteria. It discusses imaging requirements, definitions of response assessments including complete response, partial response, stable disease, and progressive disease. It also covers special considerations like pseudo progression and pseudo response that can mimic tumor progression or response. Several case examples are presented to demonstrate application of the RANO criteria.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    52 views31 pages

    Response Assessment in Neuro-Oncology (RANO)

    Uploaded by

    Rini Andriani
    This document summarizes response assessment criteria for central and peripheral nervous system tumors, specifically the Response Assessment in Neuro-Oncology (RANO) criteria. It discusses imaging requirements, definitions of response assessments including complete response, partial response, stable disease, and progressive disease. It also covers special considerations like pseudo progression and pseudo response that can mimic tumor progression or response. Several case examples are presented to demonstrate application of the RANO criteria.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
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    RINI ANDRIANI

    CENTRAL AND PERIPHERAL NERVOUS SYSTEM TUMOR BOARD


    DHARMAIS NATIONAL CANCER HOSPITAL

    Response Assessment in Neuro-Oncology (RANO)


    • Response Assessment
    • As the standard for in Neuro-Oncology
    (RANO)
    Theassessment of 2010
    1990
    The MacDonald criteria response and
    MacDonald
    progression • Assessing disease
    criteria
    • HGG progression and
    treatment response
    in glioblastoma
    multiforme (GBM)

    The product of the maximal Pseudo progression


    perpendicular diameters
    Pseudo response
    Changes in corticosteroid doses
    Non enhancing tumor progression
    Changes neurologic function
    Summary of current response criteria.
    • Image Acquisition
    • MRI is the only modality used to assess
    response and progression
    Response • Minimum sequences required:
    Assessment in T2/FLAIR
    ■ Pre-contrast T1,

    Neuro- ■ Post-contrast T1, with two


    orthogonal planes (or a volume acquisition)
    Oncology recommended

    (RANO) • Recommended slice thickness ≤5 mm with no


    gap
    • Additional imaging that may be helpful:
    ■ Diffusion (DWI, ADC)
    Definitions
    Pseudo response

    •Antiangiogenic drug effects


    can look like response
    •Occurs within 4 weeks of
    therapy
    • Confirm CR and PR at least
    4 weeks later
    Pseudo progression
    • Enhancement that simulates tumor growth, most often caused by
    radiation (whole brain or focal).
    • Growth of existing lesions or appearance of new lesions within 12
    weeks of completion of radiation therapy may be the result of
    treatment effects rather than growth of tumor.
    • Continued follow-up imaging can determine whether initial lesion
    growth was true progression or pseudo progression.
    • If lesion continues to enlarge, the initial growth is called true
    progression
    • If lesion stabilizes or shrinks, the initial growth is confirmed as pseudo
    progression
    Laki-laki, 30 tahun,
    Fibrillaryastrocytoma
    dgn komponen
    gemistocytic grade II
    MRI Brain kontras pre terapi
    CT Scan Pre Radiasi (7x5 cm)

    Pasien masih diberikan steroid


    Status klinis tidak ada perburukan CT Scan
    Post Radiasi (6x5 cm)
    KRITERIA RANO
    Criteria

    T1-Gd+ 14 % (< 25%)

    T2/FLAIR ↓ Stabil
    Response
    New Lesion none

    Corticosteroids Stable

    Clinical Status Stable


    Sesuai guideline
    NCCN yang
    dimodifikasi
    dilakukan evaluasi
    rutin

    Pasien tidak minum steroid

    Status klinis menetap


    • T1 + Kontras • T1 + Kontras
    • 2017 • 2018
    KRITERIA RANO 2017 Vs
    2018
    Criteria

    T1-Gd+ 47,9 % (≥25%)

    T2/FLAIR ↑
    Progresive
    Disease
    New Lesion none

    Corticosteroids Stable

    Clinical Status Stable


    Wanita, 46 tahun
    PA: Anaplastik astrocytoma grade III dd anaplastik ependimoma
    IHK: GFAP: positif, S100: positif fokal,EMA: negatif, Vimentin: positif
    MGMT: positif > 50% sel tumor, EGFR: positif
    Post operasi
    RANO
    Criteria

    T1 None

    T2/FLAIR Stable

    New Lession None

    Cortico-steroid None

    Clinical Status Stable

    Pre Operasi Post operasi


    Ukuran 2,2x2,2x2,8 cm Tidak tampak lesi Summary CR
    10 Juli 2017
    RANO
    Criteria

    T1 None

    T2/FLAIR Stable

    New Lession None

    Cortico- None
    steroid

    Clinical Status Stable

    Summary CR
    26 November 2016 10 Juli 2017
    Tidak tampak lesi Tidak tampak lesi

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