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

doi:10.1093/neuonc/now183

Leptomeningeal metastases: a RANO proposal for response criteria

Neuro Oncol. 2017 Apr 1;19(4):484-492. doi: 10.1093/neuonc/now183.

Authors

Affiliations

¹ Department of Neurology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA.
² Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
³ Department of Neuro-Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.
⁴ Department of Neuro-Oncology, University Hospital, Torino, Italy.
⁵ Department of Neurology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA.
⁶ Departments of Neuro-Oncology Marazin and Radiation Oncology, Pitie-Salpetrieree Hospital and University Pierre et Marie Curie, Paris VI, Paris, France.
⁷ Austin Brain Tumor Center, Texas Oncology/US Oncology Research, Austin, Texas, USA.
⁸ Department of Neuro-Oncology, University Hospital, Department of Neurology, Oscar Lambret Center, Lille, France.
⁹ Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
¹⁰ Department of Neuro-oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, Netherlands.
¹¹ Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA.
¹² Departments of Neurology and Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA.

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.

Keywords: CSF cytology/flow cytometry; leptomeningeal metastasis; neurological examination; neuraxis MRI.

Publication types

Review

MeSH terms

Clinical Trials as Topic / standards
Disease Progression
Humans
Magnetic Resonance Imaging
Meningeal Neoplasms / cerebrospinal fluid
Meningeal Neoplasms / diagnosis*
Meningeal Neoplasms / diagnostic imaging
Meningeal Neoplasms / therapy*
Treatment Outcome