The RANO Leptomeningeal Metastasis Group proposal to assess response to treatment: lack of feasibility and clinical utility and a revised proposal

• DOI: 10.1093/neuonc/noz024
• Publication Date: 2019-01-23T15:20:30Z
• Authors: Emilie Le Rhun; Patrick Devos; Thomas Boulanger; Marion Smits; Dieta Brandsma; Roberta Rudà; Julia Furtner; Johann-Martin Hempel; Tjeerd J Postma; Patrick Roth; Tom J Snijders; Frank Winkler; Sebastian Winklhofer; Antonella Castellano; Elke Hattingen; Jaume Capellades; Thierry Gorlia; Martin Van den Bent; Patrick Y Wen; Martin Bendszus; Michael Weller
• Keywords: Concordance; Concordance correlation coefficient; Cohen's kappa

A scorecard to evaluate magnetic resonance imaging (MRI) findings during the course of leptomeningeal metastases (LM) has been proposed by Response Assessment in Neuro-Oncology (RANO) group.To explore feasibility Leptomeningeal (LANO) scorecard, cerebrospinal MRIs 22 patients with LM from solid tumors were scored 10 neuro-oncologists and 9 neuroradiologists at baseline follow-up after treatment. Raters blinded for clinical data including Agreement between raters single items was evaluated using a Krippendorff alpha coefficient. numerical parameters such as scores changes total determining intraclass coefficient correlation.Most experienced problems instructions scorecard. No acceptable concordance obtained rating or follow-up. The most concordant ratings spinal nodules. concordances worst brain linear enhancement cranial nerve enhancement. Discordance less prominent among than neuro-oncologists. High variability also observed evaluating scores.Assessing response MRI remains challenging. Central review is therefore indispensable trials. Based on present results, we propose new, simplified that will require validation similar approach pursued here. main challenges are define measurable versus nonmeasurable (target) lesions measures change allow assessment response.