Evaluation of the implementation of the response assessment in neuro-oncology criteria in the HERBY trial of pediatric patients with newly diagnosed high-grade gliomas
Rodriguez, D.; Chambers, T.; Warmuth-Metz, M.; Sanchez Aliaga, E.; Warren, D.; Calmon, R.; Hargrave, D.; Garcia, J.; Vassal, G.; Grill, J.; Zahlmann, G.; Morgan, P.S.; Jaspan, T.
E. Sanchez Aliaga
BACKGROUND AND PURPOSE: Our aim was to evaluate implementation of the radiologic aspects of HERBY, a Phase II multicenter study setup to establish the efficacy and safety of adding bevacizumab to radiation therapy and temozolomide in pediatric patients with newly diagnosed non-brain stem high-grade gliomas and the practicality and feasibility of including multimodal imaging in the Response Assessment in Neuro-Oncology criteria in a pediatric high-grade-glioma cohort.
MATERIALS AND METHODS: We analyzed multimodal imaging compliance rates and scan quality for participating sites, adjudication rates and reading times for the central review process, the influence of different Response Assessment in Neuro-Oncology criteria in the final response, the incidence of pseudoprogression, and the benefit of incorporating multimodal imaging into the decision process.
RESULTS: Multimodal imaging compliance rates were the following: diffusion, 82%; perfusion, 60%; and spectroscopy, 48%. Neuroradiologists’ responses differed for 50% of scans, requiring adjudication, with a total average reading time per patient of approximately 3 hours. Pseudoprogression occurred in 10/116 (9%) cases, 8 in the radiation therapy/temozolomide arm and 2 in the bevacizumab arm (P _ .01). Increased target enhancing lesion diameter was a reason for progression in 8/86 cases (9.3%) but never the only radiologic or clinical reason. Event-free survival was predicted earlier in 5/86 (5.8%) patients by multimodal imaging (diffusion, n _ 4; perfusion, n _ 1).
CONCLUSIONS: The addition of multimodal imaging to the response criteria modified the assessment in a small number of cases, determining progression earlier than structural imaging alone. Increased target lesion diameter, accounting for a large proportion of reading time, was never the only reason to designate disease progression.
|Journal Article Type||Article|
|Publication Date||Mar 1, 2019|
|Publisher||American Society of Neuroradiology|
|Peer Reviewed||Peer Reviewed|
|APA6 Citation||Rodriguez, D., Chambers, T., Warmuth-Metz, M., Sanchez Aliaga, E., Warren, D., Calmon, R., …Jaspan, T. (2019). Evaluation of the implementation of the response assessment in neuro-oncology criteria in the HERBY trial of pediatric patients with newly diagnosed high-grade gliomas. American Journal of Neuroradiology, 40(3), 568-575. doi:10.3174/ajnr.A5982|
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