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., Aliaga, E. Sanchez, Warren, D., Calmon, R., Hargrave, D., Garcia, J., Vassal, G., Grill, J., Zahlmann, G., Morgan, P.S. and 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) , pp. 568-575. 10.3174/ajnr.A5982

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Abstract

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%. 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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine Psychology
Publisher:	American Society of Neuroradiology
ISSN:	0195-6108
Last Modified:	07 Oct 2022 01:29
URI:	https://orca.cardiff.ac.uk/id/eprint/125197

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