What are Rano criteria?
As shown in Fig 1, the RANO criteria define measurable disease as bidimensional contrast-enhancing lesions with clearly defined margins, with 2 perpendicular diameters of at least 10 mm, visible on ≥2 axial slices.
What is Pseudoprogression?
Pseudoprogression is defined as an increase in the size of the primary tumor or the appearance of a new lesion followed by tumor regression.
What is Pseudoprogression in glioblastoma?
Pseudoprogression (PsP) is a transient magnetic resonance imaging (MRI) pattern mimicking tumor progression but not necessarily accompanied by clinical deterioration. It occurs most frequently during the first 3 months after radiation therapy and improvement will usually occur within a few weeks or months.
What is Pseudoprogression in brain cancer?
What Is Pseudoprogression? Radiologically, pseudoprogression is defined as a new or enlarging area(s) of contrast agent enhancement occurring early after the end of radiotherapy (eg, within 3–4 months), in the absence of true tumor growth, which subsides or stabilizes without a change in therapy7 (Fig.
What is Rano BM?
The Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) working group is an international, multidisciplinary effort to develop standard response and progression criteria for use in clinical trials of treatment for brain metastases.
How is Pseudoprogression diagnosed?
Conventional structural MRI is insufficient for distinguishing pseudoprogression from true progressive disease, and advanced imaging is needed to obtain higher levels of diagnostic certainty. Perfusion MRI is the most widely used imaging technique to diagnose pseudoprogression and has high reported diagnostic accuracy.
What is Pseudoprogression in immunotherapy?
Pseudoprogression is a phenomenon in which an initial increase in tumor size is observed or new lesions appear, followed by a decrease in tumor burden; this phenomenon can benefit patients receiving immunotherapy but often leads to premature discontinuation of treatment owing to the false judgment of progression.
Is Pseudoprogression a good thing?
Some studies have found that pseudoprogression indicates a better outcome, though more studies are needed. While researchers work to learn more about what causes pseudoprogression and what it may mean for patients who experience it, communication between doctors and patients is critical.
How is brain necrosis treated?
Symptomatic brain necrosis should be treated with oral dexamethasone, and refractory cases may require hyperbaric oxygen therapy or surgical resection. Cognitive decline has been documented after radiation to the nasopharynx and the paranasal sinuses.
WHO criteria RECIST criteria?
The RECIST criteria are comparable to the WHO criteria in evaluating the response of colorectal carcinoma, but have simple and reproducible guidelines. The use of RECIST is recommended for evaluating the treatment efficacy in clinical trials and practice.
What is the role of pseudoprogression and pseudoresponse?
As will be discussed later, pseudoprogression and pseudoresponse are special situations in which the therapies (ie, radiation, temozolomide, and anti-VEGF agent) play a major role in the imaging appearance. Complete Response.
Is there a link between pseudoprogression and survival?
Most important, some studies have found an association between the incidence of pseudoprogression and increased survival; perhaps pseudoprogression represents an active “inflammatory” response against the tumor. 9 Fig 1. Pseudoprogression. A 59-year-old man with GBM.
How is pseudoprogression related to radiologic abnormalities?
However, in most patients, the increase in radiologic abnormalities is clinically asymptomatic. 10 Pseudoprogression is most likely induced by a pronounced local tissue reaction with an inflammatory component, edema, and abnormal vessel permeability causing new or increased contrast enhancement on MR imaging examinations.
What was the purpose of the Rano working group?
RANO working groups was established to address some of these issues and provide guidance on assessment of response and endpoints in neuro-oncology clinical trials.