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, Lisa Dobber Department of Neurology, Erasmus MC Cancer Center , Rotterdam, The Netherlands Search for other works by this author on: Oxford Academic Marjolein Geurts Department of Medical Oncology, Erasmus MC Cancer Center , Rotterdam, The Netherlands Department of Neurology, Erasmus MC Cancer Center , Rotterdam, The Netherlands Search for other works by this author on: Oxford Academic Martin J van den Bent Department of Neurology, Erasmus MC Cancer Center , Rotterdam, The Netherlands Corresponding Author: Martin van den Bent, Department of Neurology, Erasmus MC Cancer Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam 010-7041415, The Netherlands (mjvandenbent@neuro-oncology.nl). Search for other works by this author on: Oxford Academic
https://orcid.org/0000-0003-2369-0035 Neuro-Oncology, noae095, https://doi.org/10.1093/neuonc/noae095
Published:
10 June 2024
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Corrected and typeset:
10 June 2024
Published:
10 June 2024
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Lisa Dobber, Marjolein Geurts, Martin J van den Bent, Tumor growth in recurrent glioblastoma—RANO: when to plan the baseline scan?, Neuro-Oncology, 2024;, noae095, https://doi.org/10.1093/neuonc/noae095
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Glioblastoma is the most common primary malignant brain tumor for which no curative treatment exists. Little is known about its growth rate once disease progression occurs. This is relevant for the timing of baseline imaging for second-line treatment in clinical trials and subsequent response monitoring. Although most trial protocols allow a 2–3-week interval between obtaining a baseline scan for study entry and therapy initiation, the 2022 revised RANO 2.0 criteria recommend an interval no greater than 14 days.1,2 To our knowledge, no evidence for this interval exists. If a tumor grows rapidly in the period between imaging and the start of treatment, adequate response assessment may be hindered leading to false interpretations of progression to the experimental treatment. We assessed whether the tumor area differs between the scan showing progressive disease (“progression scan”) and the scan for study entry (“baseline scan”) to determine the tumor growth rate.
In this single-center study, adult patients at the Erasmus MC in Rotterdam, the Netherlands, with a radiologically confirmed first glioblastoma recurrence enrolled in a clinical trial between 2011 and 2023 were checked for eligibility. First recurrence (progressive disease, PD) after standard of care was established per physicians’ judgment either at Erasmus MC or the referring hospital. All studies required a 3-month interval between the end of radiotherapy and study enrollment. Patients were included if they had 2 available MRI scans with measurable disease made within ≤35-day interval between the progression scan and baseline scan. Patients who underwent re-resection were excluded. Three independent observers calculated the tumor areas from the identified scans using the 2-dimensional maximal perpendicular measure on T1 contrast-enhanced axial imaging (RANO 2.0).2 Using the measurements’ mean, the percentage change in tumor area was calculated and compared to RANO’s ≥25% definition of disease progression. We chose 17 days as a landmark to evaluate the number of patients with tumor progression considering this is the maximum interval allowed by recent studies (eg, NCT01986348, NCT04910022).
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