Leptomeningeal metastases: a RANO proposal for response criteria
Leptomeningeal metastases: a RANO proposal for response criteria
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DOI：
10.1093/neuonc/now183
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发表时间：
2017-04-01
期刊：
影响因子：
15.9
通讯作者：
Jaeckle, Kurt A.
中科院分区：
文献类型：
--
作者：
Chamberlain, Marc;Junck, Larry;Jaeckle, Kurt A.
软脑膜转移瘤（LM）目前缺乏标准化的反应评估。具有LM专业知识的神经肿瘤学缓解评估（RANO）工作组制定了一项共识提案，用于评估接受该疾病治疗的患者。提出了评估LM反应的三个基本要素：标准化的神经系统检查、脑脊液（CSF）细胞学或流式细胞术和影像学评价。该小组建议所有入组临床试验的患者接受CSF分析（所有癌症的细胞学检查;血液学癌症的流式细胞术），完整的对比增强神经轴MRI，以及计划的CSF内治疗，放射性同位素CSF流量研究。与RANO神经学评估工作组合作，创建了一种标准化工具，用于评估LM患者的神经学检查。考虑到LM中的大多数病变是不可测量的，并且LM中的神经影像学评估是主观的，使用新型放射学LM缓解评分卡将神经影像学分级为稳定、进展或改善。单独的影像学疾病进展（即CSF细胞学/流式细胞术阴性和稳定的神经系统评估）定义为LM疾病进展。RANO LM工作组提出了一种用于LM患者的缓解评价方法，该方法需要进一步测试、验证和可能的使用改进。
Leptomeningeal metastases (LM) currently lack standardization with respect to response assessment. A Response Assessment in Neuro-Oncology (RANO) working group with expertise in LM developed a consensus proposal for evaluating patients treated for this disease. Three basic elements in assessing response in LM are proposed: a standardized neurological examination, cerebral spinal fluid (CSF) cytology or flow cytometry, and radiographic evaluation. The group recommends that all patients enrolling in clinical trials undergo CSF analysis (cytology in all cancers; flow cytometry in hematologic cancers), complete contrast-enhanced neuraxis MRI, and in instances of planned intra-CSF therapy, radioisotope CSF flow studies. In conjunction with the RANO Neurological Assessment working group, a standardized instrument was created for assessing the neurological exam in patients with LM. Considering that most lesions in LM are nonmeasurable and that assessment of neuroimaging in LM is subjective, neuroimaging is graded as stable, progressive, or improved using a novel radiological LM response scorecard. Radiographic disease progression in isolation (ie, negative CSF cytology/flow cytometry and stable neurological assessment) would be defined as LM disease progression. The RANO LM working group has proposed a method of response evaluation for patients with LM that will require further testing, validation, and likely refinement with use.