Alexander Tinchon1,2, Franz Marhold3, Bernadette Calabek-Wohinz1,2, Katharina Hainz1, Martina Tesar-Pelz1, Gregory Minear4, Elisabeth Freydl1, Katrin Blauensteiner1, Gertraud Heinz5, Stefan Oberndorfer6,7,8. 1. Department of Neurology, Unit for Neurooncology, University Hospital of St. Pölten-KLPU, St. Pölten, Austria. 2. Karl Landsteiner Institute for Neurology and Neuropsychology, St. Pölten, Austria. 3. Department of Neurosurgery, University Hospital of St. Pölten-KLPU, St. Pölten, Austria. 4. Department of Nuclear Medicine, University Hospital of St. Pölten-KLPU, St. St. Pölten, Austria. 5. Department of Radiology, University Hospital of St. Pölten-KLPU, St. Pölten, Austria. 6. Department of Neurology, Unit for Neurooncology, University Hospital of St. Pölten-KLPU, St. Pölten, Austria. stefan.oberndorfer@stpoelten.lknoe.at. 7. Karl Landsteiner Institute for Neurology and Neuropsychology, St. Pölten, Austria. stefan.oberndorfer@stpoelten.lknoe.at. 8. Neurological Department, University Hospital of St. Pölten, Dunant Platz 1, 3100, St. Pölten, Austria. stefan.oberndorfer@stpoelten.lknoe.at.
Abstract
BACKGROUND: Assessment of disease activity in glioblastoma (GBM) can be challenging due to several clinical and radiological pitfalls. Besides MRI, FET-PET and neurocognitive assessment (NA) are used in several neuro-oncological centers in order to improve the specificity of response assessment. We performed a retrospective study to investigate whether the assessment by RANO (Response Assessment in NeuroOncology) corresponds to FET-PET imaging and NA results. Moreover, the concordance of RANO with a final recommendation of an interdisciplinary neuro-oncological tumor board recommendation (TBR) was analyzed. METHODS: We enrolled 25 consecutive patients with newly diagnosed histologically confirmed GBM in a pilot study, accounting for 81 multimodal test results. All patients were selected after undergoing consecutive follow-up comprising MRI, FET-PET, and NA with a subsequent TBR. Results were analyzed for correlations between RANO, FET-PET and NA. An additional consistency analysis was performed to elucidate the impact of RANO on decision making. RESULTS: A highly statistically significant correlation was found between RANO and FET-PET and NA results (all P < 0.01); however, 26% of follow-up tests exhibited inconsistent results in multimodal assessment, among which RANO was only 48% in accordance with the final TBR. The concordance of NA and FET-PET with the final TBR was 67% and 86%, respectively. CONCLUSION: The RANO proved its value in the context of multimodal assessment of disease activity in GBM; however, because the implementation of multimodal assessment showed a considerably high percentage of inconsistent results, further studies are required to investigate the relationship between different assessment techniques, in addition to their overall significance to response rating.
BACKGROUND: Assessment of disease activity in glioblastoma (GBM) can be challenging due to several clinical and radiological pitfalls. Besides MRI, FET-PET and neurocognitive assessment (NA) are used in several neuro-oncological centers in order to improve the specificity of response assessment. We performed a retrospective study to investigate whether the assessment by RANO (Response Assessment in NeuroOncology) corresponds to FET-PET imaging and NA results. Moreover, the concordance of RANO with a final recommendation of an interdisciplinary neuro-oncological tumor board recommendation (TBR) was analyzed. METHODS: We enrolled 25 consecutive patients with newly diagnosed histologically confirmed GBM in a pilot study, accounting for 81 multimodal test results. All patients were selected after undergoing consecutive follow-up comprising MRI, FET-PET, and NA with a subsequent TBR. Results were analyzed for correlations between RANO, FET-PET and NA. An additional consistency analysis was performed to elucidate the impact of RANO on decision making. RESULTS: A highly statistically significant correlation was found between RANO and FET-PET and NA results (all P < 0.01); however, 26% of follow-up tests exhibited inconsistent results in multimodal assessment, among which RANO was only 48% in accordance with the final TBR. The concordance of NA and FET-PET with the final TBR was 67% and 86%, respectively. CONCLUSION: The RANO proved its value in the context of multimodal assessment of disease activity in GBM; however, because the implementation of multimodal assessment showed a considerably high percentage of inconsistent results, further studies are required to investigate the relationship between different assessment techniques, in addition to their overall significance to response rating.