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.

Abstract

© 2019 American Society of Neuroradiology. All rights reserved. BACKGROUND AND PURPOSE: HERBY was a Phase II multicenter trial 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. This study evaluates the implementation of the radiologic aspects of HERBY. 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%. Neuroradi-ologists’ 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.

Citation

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. (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. https://doi.org/10.3174/ajnr.A5982

• Journal Article Type: Article
• Acceptance Date: Dec 31, 2018
• Online Publication Date: Feb 28, 2019
• Publication Date: Jan 1, 2019
• Deposit Date: Feb 28, 2019
• Journal: American Journal of Neuroradiology
• Print ISSN: 0195-6108
• Electronic ISSN: 1936-959X
• Publisher: American Society of Neuroradiology
• Peer Reviewed: Peer Reviewed
• Volume: 40
• Issue: 3
• Pages: 568-575
• DOI: https://doi.org/10.3174/ajnr.A5982
• Keywords: Radiology Nuclear Medicine and imaging; Clinical Neurology
• Public URL: https://nottingham-repository.worktribe.com/output/1592600
• Publisher URL: http://www.ajnr.org/content/40/3/568