CLRM-07 RANO 2.0: PROPOSAL FOR AN UPDATE TO THE RESPONSE ASSESSMENT IN NEURO-ONCOLOGY (RANO) CRITERIA FOR HIGH- AND LOW-GRADE GLIOMAS IN ADULTS

Abstract The Response Assessment in Neuro-Oncology (RANO) criteria for high-grade gliomas (RANO-HGG) and low-grade (RANO-LGG) were developed to improve the reliability of response assessment glioma trials. Over time some limitations these identified, uncertainty emerged regarding integrating features modified RANO (mRANO) or immunotherapy (iRANO) criteria. Informed by data from a cohort glioblastoma patients other evaluations that allowed evaluation different criteria, we propose updates (RANO 2.0). Based on 2021 WHO classification gliomas, recommend standard set both high be used all trials regardless treatment modalities being evaluated. In newly diagnosed setting, post-radiotherapy MRI, rather than post-surgical will as baseline future comparison. Since incidence pseudoprogression is 12 weeks following radiotherapy, continuation confirmation progression during this period with repeat histopathologic evidence unequivocal recurrent tumor, required define tumor progression. However, scans are not mandatory after nor tumors. For treatments likelihood pseudoprogression, MRI an option. primary measurement remains maximum cross-sectional area (2-dimensional) but volumetric measurements IDH-wildtype glioblastoma, non-enhancing disease no longer IDH-mutated tumors significant component, clinical may require evaluating enhancing components assessment.