Monitoring DMG Treatment Response Using RANO 2.0 Criteria

Funding support provided by Chimerix/Jazz Pharmaceuticals. Content independently developed and published by OncLive.

The Response Assessment in Neuro-Oncology (RANO) criteria have undergone multiple refinements over the years, culminating in the updated RANO 2.0 framework. Originally based on measurements of contrast-enhancing tumor regions, the criteria evolved to better capture the complexity of glioma behavior under different therapies, including immunotherapy. The RANO 2.0 update was designed to standardize assessments across both high- and low-grade gliomas, providing clearer and more consistent benchmarks for clinicians to evaluate treatment response.

Key features of RANO 2.0 include the use of the post-radiation therapy MRI as the new baseline for evaluating progression. Confirmation of progression is typically sought with repeat imaging or pathology around 12 weeks after radiation, though these confirmatory scans are not mandated in every case. Importantly, the criteria affirm that 2D measurements remain sufficient, even though volumetric analysis would provide more comprehensive data. This change was meant to make the guidelines more practical for use across community and academic settings.

Other significant updates include the removal of non-enhancing disease evaluation for IDH-wild type glioblastoma, while still requiring both FLAIR and T1 post-contrast imaging assessments for IDH-mutant gliomas with non-enhancing components. Despite these refinements, the RANO 2.0 authors acknowledged limitations, such as ongoing challenges in differentiating treatment-related changes from true progression. Nevertheless, this iteration represents a major step toward consistency in clinical trial design and everyday practice, giving community clinicians a clearer pathway to align with expert consensus.