====== Modified RANO Criteria ======

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In [[2010]], the [[RANO criteria]] for [[high-grade glioma]]s was developed by a [[consensus]] of [[expert]]s to [[update]] the original Macdonald criteria and account for challenges to response assessment such as [[pseudoprogression]] and [[pseudoresponse]]. Subsequent studies have suggested a limited benefit of incorporating [[T2]]/[[FLAIR]] evaluation on the correlation of [[PFS]] with [[OS]]. Moreover, some new therapies, particularly [[immunotherapy]] and viral therapies, are more likely to induce transient worsening of contrast enhancement that might lead to erroneous determination of radiographic disease progression. As a result, the modified RANO criteria were proposed in [[2017]] and differed from [[RANO]] by use of the post-radiation scan as the baseline scan, omission of FLAIR evaluation, and requirement of a confirmation scan to determine progressive disease.
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The [[Response]] [[Assessment]] in [[Neuro-Oncology]] ([[RANO]]) [[criteria]] for [[high-grade glioma]]s (RANO-HGG) and [[low-grade glioma]]s (RANO-LGG) were developed to improve the reliability of response assessment in glioma trials. Over time, some limitations of these criteria were identified, and challenges emerged regarding integrating features of the [[modified RANO criteria]] (mRANO) or the immunotherapy RANO (iRANO) criteria.

Informed by data from studies evaluating the different criteria, updates to the RANO criteria are proposed (RANO 2.0).

They recommend a standard set of criteria for both high- and low-grade gliomas, to be used for all trials regardless of the treatment modalities being evaluated. In the newly diagnosed setting, the postradiotherapy magnetic resonance imaging (MRI), rather than the postsurgical MRI, will be used as the baseline for comparison with subsequent scans. Since the incidence of [[pseudoprogression]] is high in the 12 weeks after radiotherapy, continuation of treatment and confirmation of progression during this period with a repeat MRI, or histopathologic evidence of unequivocal recurrent tumor, are required to define tumor progression. However, confirmation scans are not mandatory after this period nor for the evaluation of treatment for recurrent tumors. For treatments with a high likelihood of pseudoprogression, mandatory confirmation of [[progression]] with a repeat MRI is highly recommended. The primary measurement remains the maximum [[cross-sectional area]] of the tumor (two-dimensional) but volumetric measurements are an option. For IDH wild-type glioblastoma, the non-enhancing disease will no longer be evaluated except when assessing response to antiangiogenic agents. In IDH-mutated tumors with a significant non-enhancing component, clinical trials may require evaluating both the enhancing and non-enhancing tumor components for response assessment
((Wen PY, van den Bent M, Youssef G, Cloughesy TF, Ellingson BM, Weller M, Galanis E, Barboriak DP, de Groot J, Gilbert MR, Huang R, Lassman AB, Mehta M, Molinaro AM, Preusser M, Rahman R, Shankar LK, Stupp R, Villanueva-Meyer JE, Wick W, Macdonald DR, Reardon DA, Vogelbaum MA, Chang SM. RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults. J Clin Oncol. 2023 Nov 20;41(33):5187-5199. doi: 10.1200/JCO.23.01059. Epub 2023 Sep 29. PMID: 37774317.)).