scholarly journals Pitfalls in the radiological response assessment of immunotherapy

2018 ◽  
Vol 11 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Lucian Beer ◽  
Maximilian Hochmair ◽  
Helmut Prosch
Keyword(s):  
Response Assessment ◽  
Radiological Response

scholarly journals A novel, reproducible, and objective method for volumetric magnetic resonance imaging assessment of enhancing glioblastoma

2014 ◽  
Vol 121 (3) ◽  
pp. 536-542 ◽  
Author(s):  
Charles W. Kanaly ◽  
Ankit I. Mehta ◽  
Dale Ding ◽  
Jenny K. Hoang ◽  
Peter G. Kranz ◽  
...  
Keyword(s):  
Interobserver Variability ◽  
Intraclass Correlation ◽  
Evaluation Criteria ◽  
Correlation Coefficients ◽  
Response Assessment ◽  
Volumetric Method ◽  
Kappa Statistics ◽  
Macdonald Criteria ◽  
Automated Method ◽  
Radiological Response

Object Robust methodology that allows objective, automated, and observer-independent measurements of brain tumor volume, especially after resection, is lacking. Thus, determination of tumor response and progression in neurooncology is unreliable. The objective of this study was to determine if a semi-automated volumetric method for quantifying enhancing tissue would perform with high reproducibility and low interobserver variability. Methods Fifty-seven MR images from 13 patients with glioblastoma were assessed using our method, by 2 neuroradiologists, 1 neurosurgeon, 1 neurosurgical resident, 1 nurse practitioner, and 1 medical student. The 2 neuroradiologists also performed traditional 1-dimensional (1D) and 2-dimensional (2D) measurements. Intraclass correlation coefficients (ICCs) assessed interobserver variability between measurements. Radiological response was determined using Response Evaluation Criteria In Solid Tumors (RECIST) guidelines and Macdonald criteria. Kappa statistics described interobserver variability of volumetric radiological response determinations. Results There was strong agreement for 1D (RECIST) and 2D (Macdonald) measurements between neuroradiologists (ICC = 0.42 and 0.61, respectively), but the agreement using the authors' novel automated approach was significantly stronger (ICC = 0.97). The volumetric method had the strongest agreement with regard to radiological response (κ = 0.96) when compared with 2D (κ = 0.54) or 1D (κ = 0.46) methods. Despite diverse levels of experience of the users of the volumetric method, measurements using the volumetric program remained remarkably consistent in all users (0.94). Conclusions Interobserver variability using this new semi-automated method is less than the variability with traditional methods of tumor measurement. This new method is objective, quick, and highly reproducible among operators with varying levels of expertise. This approach should be further evaluated as a potential standard for response assessment based on contrast enhancement in brain tumors.

P14.86 Predictive value of MGMT promoter (pMGMT) methylation status on pseudoprogression (PsP) and survival analysis in Glioblastoma (GBM) patients: a retrospective single institutional analysis

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii54-ii54
Author(s):  
V Interno’ ◽  
P De Santis ◽  
L Stucci ◽  
C Porta
Keyword(s):  
Survival Analysis ◽  
Brain Mri ◽  
Methylation Status ◽  
Response Assessment ◽  
Potential Effect ◽  
Primary Brain Tumor ◽  
Survival Outcome ◽  
Maximal Extension ◽  
Radiological Response ◽  
True Progression

Abstract BACKGROUND Glioblastoma is the most common and aggressive primary brain tumor. Conventional therapies, such as maximal extension of surgery followed by radiotherapy (RT) and chemotherapy with Temozolomide (TMZ) have not resulted in major improvements in terms of patients’ outcome, overall survival (OS) still remaining poor. In this context, radiological response assessment after radiotherapy remains challenging due to the potential effect of radionecrosis, often mimicking tumor progression. Differentiation between PsP and true progression is required to avoid further unnecessary surgeries, or the premature discontinuation of TMZ. It is known that pMGMT methylated patients respond better to chemotherapy than unmethylated counterpart, so, tumor cells necrosis can be enhanced in this setting. The aim of the study is to observe the correlation between pMGMT methylation status with the incidence of PsP in GBM patients at the first radiological evaluation after RT. MATERIALS AND METHODS Patients with histologically diagnosis of GBM from 2017 to 2021 and availability of pMGMT methylation status were enrolled. PsP was radiologically defined at first brain MRI after RT in case of increasing size of the enhancing component and of peritumoral oedema that remain stable or decrease after antioedema therapy, such as a clinical improvement was observed. RESULTS We analysed 55 GBM patients, 35 (64%) displayed pMGMT methylation whereas 20 (36%) resulted pMGMT unmethylated. PsP was evident in 29 patients (53%), all of them showed methylation of pMGMT. In our analysis, none of pMGMT unmethylated patients experienced PsP. Regarding survival outcome for pMGMT methylated patients, our analysis shows a mPFS of 8.7 (95% CI: 5–10) months versus 9.3 (95%CI: 4.6–12.3) months in methylated and unmethylated respectively (p=0.87). CONCLUSIONS Methylation status of pMGMT showed to be predictor of PsP in GBM patients. If validated, this information could be very useful to guide clinicians in differentiating PsP from true progression. To date, our survival analysis regarding PFS showed no statistical difference among methylated patients with respect to the presence or absence of PsP. Thus, PsP seems not to be a marker of responsiveness to common treatment. Further data are needed to validate our results.

scholarly journals Early Pseudoprogression following Chemoradiotherapy in Glioblastoma Patients: The Value of RANO Evaluation

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Paulo Linhares ◽  
Bruno Carvalho ◽  
Rita Figueiredo ◽  
Rui M. Reis ◽  
Rui Vaz
Keyword(s):  
Survival Data ◽  
Response Assessment ◽  
Rank Analysis ◽  
Rano Criteria ◽  
Macdonald Criteria ◽  
Kaplan Meier ◽  
Early Progression ◽  
Radiological Response ◽  
The Impact ◽  
True Progression

Introduction. The aim of this study was to determine the frequency of pseudoprogression in a cohort of glioblastoma (GBM) patients following radiotherapy/temozolomide (RT/TMZ) by comparing Macdonald criterial to Response Assessment in Neuro-Oncology (RANO) criteria. The impact on prognosis and survival analysis was also studied.Materials and Methods. All patients receiving RT/TMZ for newly diagnosed GBM from January 2005 to December 2009 were retrospectively evaluated, and demographic, clinical, radiographic, treatment, and survival data were reviewed. Updated RANO criteria were used for the evaluation of the pre-RT and post-RT MRI and compared to classic Macdonald criteria. Survival data was evaluated using the Kaplan-Meier and log-rank analysis.Results and Discussion. 70 patients were available for full radiological response assessment. Early progression was confirmed in 42 patients (60%) according to Macdonald criteria and 15 patients (21%) according to RANO criteria. Pseudoprogression was identified in 10 (23.8%) or 2 (13.3%) patients in Macdonald and RANO groups, respectively. Cumulative survival of pseudoprogression group was higher than that of true progression group and not statistically different from the non-progressive disease group.Conclusion. In this cohort, the frequency of pseudoprogression varied between 13% and 24%, being overdiagnosed by older Macdonald criteria, which emphasizes the importance of RANO criteria and new radiological biomarkers for correct response evaluation.

scholarly journals NIMG-13. RADIOLOGICAL RESPONSE ASSESSMENT IN THE ERA OF BEVACIZUMAB: RANO OR VOLUMETRY? A REPORT FROM THE BELOB TRIAL

2016 ◽  
Vol 18 (suppl_6) ◽  
pp. vi126-vi126 ◽  
Author(s):  
Renske Gahrmann ◽  
Martin van den Bent ◽  
B. van der Holt ◽  
R. Vernhout ◽  
W. Taal ◽  
...  
Keyword(s):  
Response Assessment ◽  
Radiological Response

scholarly journals Extent of radiological response does not reflect survival in primary central nervous system lymphoma

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Matthijs van der Meulen ◽  
Alida A Postma ◽  
Marion Smits ◽  
Katerina Bakunina ◽  
Monique C Minnema ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Overall Survival ◽  
Nervous System ◽  
Central Nervous System Lymphoma ◽  
Response Assessment ◽  
Complete Response ◽  
Rank Test ◽  
Central Response ◽  
Radiological Response ◽  
Tumor Measurements

Abstract Background In primary central nervous system lymphoma (PCNSL), small enhancing lesions can persist after treatment. It is unknown whether a difference in response category (complete response [CR], complete response unconfirmed [CRu], or partial response [PR]) reflects survival. We aimed to determine the value of a central radiology review on response assessment and whether the extent of response influenced progression-free and/or overall survival. Methods All patients in the HOVON 105/ALLG NHL 24 study with at least a baseline MRI and one MRI made for response evaluation available for central review were included. Tumor measurements were done by 2 independent central reviewers, disagreements were adjudicated by a third reviewer. Crude agreement and interobserver agreement (Cohen's kappa) were calculated. Differences in progression-free and overall survival between different categories of response at the end-of-protocol-treatment were assessed by the log-rank test in a landmark survival-analysis. Results Agreement between the central reviewers was 61.7% and between local and central response assessment was 63.0%. Cohen's kappa's, which corrects for expected agreement, were 0.44 and 0.46 (moderate), respectively. Progression agreement or not was 93.3% (kappa 0.87) between local and central response assessment. There were no significant differences in progression-free and overall survival between patients with CR, CRu, or PR at the end-of-protocol-treatment, according to both local and central response assessment. Conclusions Reliability of response assessment (CR/CRu/PR) is moderate even by central radiology review and these response categories do not reliably predict survival. Therefore, primary outcome in PCNSL studies should be survival rather than CR or CR/CRu-rate.

PRRT neuroendocrine tumor response assessment using blood transcript analysis: The NETest.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 625-625
Author(s):  
Lisa Bodei ◽  
Mark A. Kidd ◽  
Aviral Singh ◽  
Wouter A van der Zwan ◽  
Stefano Severi ◽  
...  
Keyword(s):  
Surrogate Marker ◽  
Peptide Receptor Radionuclide Therapy ◽  
Response Prediction ◽  
Response Assessment ◽  
Complete Response ◽  
Kaplan Meier ◽  
Monitoring Accuracy ◽  
Radiological Response ◽  
Imaging Response

625 Background: Peptide receptor radionuclide therapy (PRRT) is effective for metastatic/inoperable neuroendocrine tumors (NETs). Imaging response assessment is most effective after treatment completion. Blood biomarkers such as PRRT Predictive Quotient (PPQ) and NETest are effective in real-time. PPQ predicts PRRT efficacy, NETest monitors disease. We prospectively evaluated: 1) NETest as a surrogate biomarker for RECIST; 2) Correlation of NETest levels, PPQ prediction and treatment efficacy. Methods: Three independent 177Lu-PRRT-treated GEP-NET and BPNEN cohorts (Rotterdam, Netherlands: n=41; Bad-Berka, Germany: n=44; Meldola, Italy: n=72). Treatment response: RECIST1.1 [Responder (stable, partial/complete response) vs Non-Responder]. Blood sampling: pre-PRRT, prior to each cycle and 6 months (median) after completion of all cycles. PPQ (positive/negative) and NETest (0-100 score) by PCR. Stable<40; progressive >40). CgA (ELISA) as comparator. Samples deidentified, measurement and analyses blinded. Kaplan-Meier survival and Mann-Whitney analyses. Results: 122 of 157 were evaluable. RECIST stabilization or response in 67%; 33% progressed. NETest significantly ( p<0.0001) decreased in RECIST-“responders” (-47±3%); in “non-responders” it elevated (+79±19%, p<0.0005). NETest monitoring accuracy 98% (119/122). Follow-up levels >40 (progressive) vs stable (<40) significantly correlated with mPFS (not reached vs. 10 months; HR 0.04, 95%CI: 0.02-0.07). PPQ response prediction was accurate in 118 (97%); 99% accurate positive and 93% accurate negative prediction. NETest significantly ( p<0.0001) decreased in PPQ-predicted responders (-46±3%) and remained increased in PPQ-predicted non-responders (+75±19%). Follow-up NETest categories stable vs progressive significantly correlated with PPQ prediction and mPFS (not reached vs. 10 months; HR 0.06, 95%CI: 0.03-0.12). CgA failed to identify response to PRRT ( p=NS). Conclusions: NETest accurately (98%) monitors PRRT response and is an effective surrogate marker for radiological response (image concordance 98%). A NETest decrease identified responders and correlated (>97%) with the pretreatment PPQ response predictor.

scholarly journals OS4.2 Radiological response assessment in the era of bevacizumab: RANO or volumetry? A report from the BELOB trial.

2016 ◽  
Vol 18 (suppl_4) ◽  
pp. iv9-iv9
Author(s):  
R. Gahrmann ◽  
M. van den Bent ◽  
B. van der Holt ◽  
R. Vernhout ◽  
W. Taal ◽  
...  
Keyword(s):  
Response Assessment ◽  
Radiological Response

scholarly journals Bevacizumab in Recurrent High-Grade Gliomas: A Canadian Retrospective Study

2017 ◽  
Vol 45 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Mary Jane Lim Fat ◽  
Catherine Maurice ◽  
Manjula Maganti ◽  
Warren P. Mason
Keyword(s):  
Clinical Outcomes ◽  
Progression Free Survival ◽  
Response Assessment ◽  
Recurrent Glioblastoma ◽  
Published Data ◽  
Clinical Progression ◽  
Patient Demographics ◽  
Canadian Experience ◽  
Radiological Response ◽  
Phase Ii And Iii

AbstractBackground: Bevacizumab has been used in recurrent glioblastoma (rGBM) since 2010 in Canada. Given its cost, potential toxicities, and unclear efficacy, further studies are required to better define suitable candidates for therapy. Methods: A single-center retrospective review of patients started on bevacizumab for rGBM from 2012 to 2015 was performed. Patient demographics, tumor characteristics, treatment regimen, and dates of clinical progression and death were collected. Overall survival (OS) and progression-free survival (PFS) were used as clinical outcomes and estimates. Radiological response was assessed using modified Response Assessment in Neuro-Oncology criteria. Results: A total of 80 patients were included. There were 67 reported deaths, and the median OS was 9.2 months (95% confidence interval [CI95%]=7.0-10.1 months), with a 12-month OS of 31% (CI95%=21.9-43.5%). Some 79 patients were included for analysis of clinical progression, among whom 61 had documented clinical progression. The median clinical PFS was 4.6 months (CI95%=3.8-6.4 months), and the 6-month clinical PFS was 39% (CI95%=29.0-52.9%). Addition of chemotherapy did not improve clinical outcomes. A total of 68 patients were included for radiological progression analysis, with 58 radiological progressions. The median radiological PFS was 5.8 months (CI95%=4.2-6.7 months), and the 6-month radiological PFS was 46% (CI95%=35.6-60.0%). Conclusions: This is the first reported Canadian experience with bevacizumab for rGBM. Our clinical outcomes are consistent with published data from multicenter phase II and III trials on bevacizumab in rGBM. More research is required to determine which subtype(s) of patients with rGBM could benefit from bevacizumab upon recurrence.

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