# Volumetric MRI-based response assessment and prognostic value in newly diagnosed glioblastoma: RANO 2.0 versus mRANO versus RANO

## TL;DR

This study compares three MRI-based methods for assessing tumor response in glioblastoma patients and finds that modified RANO and RANO 2.0 better predict survival outcomes than the original RANO criteria.

## Contribution

The study introduces a comparison of RANO 2.0 and modified RANO criteria against the original RANO for prognostic accuracy in glioblastoma.

## Key findings

- Median progression-free survival varied significantly across criteria, with mRANO showing the longest at 11.3 months.
- mRANO and RANO 2.0 showed stronger correlation between progression-free survival and overall survival than RANO.
- RANO 2.0 demonstrated the strongest survival risk stratification based on progression status at 8-month landmarks.

## Abstract

This retrospective study used volumetric MRI assessment to compare 3 response assessment criteria, namely, RANO (response assessment in neuro-oncology), mRANO (modified response assessment in neuro-oncology), and RANO 2.0, in patients with newly diagnosed glioblastoma (GB) treated with standard-of-care therapy. We evaluated whether progression-free survival (PFS), defined by each criterion, serves as a prognostic marker for overall survival (OS), and evaluated the impact of progression on patient outcome using landmark analyses.

A total of 137 GB patients were included. Tumor volumes were assessed using semiautomatic 3D segmentation of contrast-enhancing and T2/fluid-attenuated inversion recovery lesions on serial MRI. The PFS was determined using RANO, mRANO, and RANO 2.0 criteria. Correlation between PFS and OS was evaluated using Spearman rank test. Differences in PFS and postprogression survival were tested with the Kruskal-Wallis test and corrected for multiple testing. Landmark analyses at 8 and 12 months were conducted to assess the prognostic effect of progression, with hazard ratios (HRs) derived from Cox models.

Median PFS differed significantly across criteria: 7.9 months (RANO), 11.3 months (mRANO), and 9.7 months (RANO 2.0). The correlation of PFS with OS was best with mRANO (ρ = 0.70), followed by RANO 2.0 (ρ = 0.66) and RANO (ρ = 0.50). The highest HR for death in patients with progressive disease was seen with RANO 2.0 (HR = 3.6), followed by mRANO (HR = 3.3), and RANO (HR = 3.3) (8-month landmark).

mRANO and RANO 2.0 provided strong prognostic value in newly diagnosed GB patients. mRANO and RANO 2.0 showed strong correlation between PFS and OS, while RANO 2.0 demonstrated the strongest stratification of survival risk based on progression status at landmarks.