RANO 2.0: The revised Response Assessment in Neuro-Oncology (RANO) criteria for high- and low-grade glial tumors in adults designed for the future

A major barrier to developing better treatments for patients with brain tumors has been the challenges of accurately determining response and progression. In particular, pseudoprogression from radiochemotherapy and pseudoresponse and non-enhancing tumor progression following treatment with agents that reduce vascular permeability such as bevacizumab posed challenges not addressed by the prevailing Macdonald Criteria. The response assessment in neuro-oncology (RANO) Working Group published response criteria for high-grade gliomas (RANO-HGG) in 2010,1 and low-grade gliomas (RANO-LGG) in 2011,2 based on consensus recommendations to address these and other issues in order to improve the reliability and comparability of response assessment across clinical trials and facilitate the identification of more effective therapies. The major changes in RANO-HGG included the need for confirmation scans to determine response, exclusion of most patients in the first 3 months following completion of radiochemotherapy from enrolling into recurrent glioma trials, and the inclusion of non-enhancing tumor progression in the criteria for progression. These criteria have been widely accepted and were incorporated into most glioma clinical trials over the last decade.