Response Assessment in Pediatric Neuro-Oncology (RAPNO)

A number of issues identified by RANO are applicable to the pediatric neuro-oncology population. However, while RANO guidelines may prove valuable for assessing response and progression in adult patients, the pediatric neuro-oncology population poses unique challenges, prompting the institution of the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. This is an international group of cooperative group leaders and senior, experienced individuals from several disciplines including radiology, neurosurgery, radiation oncology, neuro-oncology, neurology and statistics, involved in the development and oversight of pediatric CNS clinical trials. In addition to response assessment issues identified in the neuro-oncology population as a whole, RAPNO has identified additional issues specific to pediatric neuro-oncology ¹⁾.

1: Hoffman LM, Jaimes C, Mankad K, Mirsky DM, Tamrazi B, Tinkle CL, Kline C, Ramasubramanian A, Malbari F, Mangum R, Lindsay H, Horne V, Daniels DJ, Keole S, Grosshans DR, Young Poussaint T, Packer R, Cavalheiro S, Bison B, Hankinson TC, Müller HL, Bartels U, Warren KE, Chintagumpala M. Response assessment in pediatric craniopharyngioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Neuro Oncol. 2022 Sep 17:noac221. doi: 10.1093/neuonc/noac221. Epub ahead of print. PMID: 36124689.

2: Lindsay HB, Massimino M, Avula S, Stivaros S, Grundy R, Metrock K, Bhatia A, Fernández-Teijeiro A, Chiapparini L, Bennett J, Wright K, Hoffman LM, Smith A, Pajtler KW, Poussaint TY, Warren KE, Foreman NK, Mirsky DM. Response assessment in paediatric intracranial ependymoma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Lancet Oncol. 2022 Aug;23(8):e393-e401. doi: 10.1016/S1470-2045(22)00222-4. PMID: 35901835.

3: Piccardo A, Albert NL, Borgwardt L, Fahey FH, Hargrave D, Galldiks N, Jehanno N, Kurch L, Law I, Lim R, Lopci E, Marner L, Morana G, Young Poussaint T, Seghers VJ, Shulkin BL, Warren KE, Traub-Weidinger T, Zucchetta P. Joint EANM/SIOPE/RAPNO practice guidelines/SNMMI procedure standards for imaging of paediatric gliomas using PET with radiolabelled amino acids and [¹⁸F]FDG: version 1.0. Eur J Nucl Med Mol Imaging. 2022 Sep;49(11):3852-3869. doi: 10.1007/s00259-022-05817-6. Epub 2022 May 10. PMID: 35536420; PMCID: PMC9399211.

4: Peng J, Kim DD, Patel JB, Zeng X, Huang J, Chang K, Xun X, Zhang C, Sollee J, Wu J, Dalal DJ, Feng X, Zhou H, Zhu C, Zou B, Jin K, Wen PY, Boxerman JL, Warren KE, Poussaint TY, States LJ, Kalpathy-Cramer J, Yang L, Huang RY, Bai HX. Deep learning-based automatic tumor burden assessment of pediatric high-grade gliomas, medulloblastomas, and other leptomeningeal seeding tumors. Neuro Oncol. 2022 Feb 1;24(2):289-299. doi: 10.1093/neuonc/noab151. Erratum in: Neuro Oncol. 2021 Dec 1;23(12):2124. PMID: 34174070; PMCID: PMC8804897.

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6: Abdalla G, Hammam A, Anjari M, D'Arco DF, Bisdas DS. Glioma surveillance imaging: current strategies, shortcomings, challenges and outlook. BJR Open. 2020 Jun 23;2(1):20200009. doi: 10.1259/bjro.20200009. PMID: 33178973; PMCID: PMC7594888.

7: Cooney TM, Cohen KJ, Guimaraes CV, Dhall G, Leach J, Massimino M, Erbetta A, Chiapparini L, Malbari F, Kramer K, Pollack IF, Baxter P, Laughlin S, Patay Z, Young Poussaint T, Warren KE. Response assessment in diffuse intrinsic pontine glioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Lancet Oncol. 2020 Jun;21(6):e330-e336. doi: 10.1016/S1470-2045(20)30166-2. Erratum in: Lancet Oncol. 2020 Aug;21(8):e372. PMID: 32502459.

8: Erker C, Tamrazi B, Poussaint TY, Mueller S, Mata-Mbemba D, Franceschi E, Brandes AA, Rao A, Haworth KB, Wen PY, Goldman S, Vezina G, MacDonald TJ, Dunkel IJ, Morgan PS, Jaspan T, Prados MD, Warren KE. Response assessment in paediatric high-grade glioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Lancet Oncol. 2020 Jun;21(6):e317-e329. doi: 10.1016/S1470-2045(20)30173-X. Erratum in: Lancet Oncol. 2020 Aug;21(8):e372. PMID: 32502458.

9: Fangusaro J, Witt O, Hernáiz Driever P, Bag AK, de Blank P, Kadom N, Kilburn L, Lober RM, Robison NJ, Fisher MJ, Packer RJ, Young Poussaint T, Papusha L, Avula S, Brandes AA, Bouffet E, Bowers D, Artemov A, Chintagumpala M, Zurakowski D, van den Bent M, Bison B, Yeom KW, Taal W, Warren KE. Response assessment in paediatric low-grade glioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Lancet Oncol. 2020 Jun;21(6):e305-e316. doi: 10.1016/S1470-2045(20)30064-4. Erratum in: Lancet Oncol. 2020 Dec;21(12):e553. PMID: 32502457.

10: Peng J, Zhou H, Tang O, Chang K, Wang P, Zeng X, Shen Q, Wu J, Xiao Y, Patel SH, Hu C, Jin K, Xiao B, Boxerman J, Gao X, Wen PY, Bai HX, Huang RY, Yang L. Evaluation of RAPNO criteria in medulloblastoma and other leptomeningeal seeding tumors using MRI and clinical data. Neuro Oncol. 2020 Oct 14;22(10):1536-1544. doi: 10.1093/neuonc/noaa072. PMID: 32215549; PMCID: PMC7566367.

11: D'Arco F, Culleton S, De Cocker LJL, Mankad K, Davila J, Tamrazi B. Current concepts in radiologic assessment of pediatric brain tumors during treatment, part 1. Pediatr Radiol. 2018 Dec;48(13):1833-1843. doi: 10.1007/s00247-018-4194-9. Epub 2018 Jul 6. PMID: 29980859.

12: Warren KE, Poussaint TY, Vezina G, Hargrave D, Packer RJ, Goldman S, Wen PY, Pollack IF, Zurakowski D, Kun LE, Prados MD, Rutkowski S, Kieran MW. Challenges with defining response to antitumor agents in pediatric neuro-oncology: a report from the response assessment in pediatric neuro-oncology (RAPNO) working group. Pediatr Blood Cancer. 2013 Sep;60(9):1397-401. doi: 10.1002/pbc.24562. Epub 2013 Apr 26. PMID: 23625747; PMCID: PMC6300142.