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1. Leptomeningeal metastatic disease: new frontiers and future directions

Author

Ozair, Ahmad, Wilding, Hannah, Bhanja, Debarati, Mikolajewicz, Nicholas, Glantz, Michael, Grossman, Stuart A., Sahgal, Arjun, Le Rhun, Emilie, Weller, Michael, Weiss, Tobias, Batchelor, Tracy T., Wen, Patrick Y., Haas-Kogan, Daphne A., Khasraw, Mustafa, Rudà, Roberta, Soffietti, Riccardo, Vollmuth, Philipp, Subbiah, Vivek, Bettegowda, Chetan, Pham, Lily C., Woodworth, Graeme F., Ahluwalia, Manmeet S., and Mansouri, Alireza

Published
2025
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4. Surgical management and outcome of newly diagnosed glioblastoma without contrast enhancement (low-grade appearance): a report of the RANO resect group.

Author

Karschnia, Philipp, Dietrich, Jorg, Bruno, Francesco, Dono, Antonio, Juenger, Stephanie, Teske, Nico, Young, Jacob, Sciortino, Tommaso, Häni, Levin, van den Bent, Martin, Weller, Michael, Vogelbaum, Michael, Morshed, Ramin, Haddad, Alexander, Molinaro, Annette, Tandon, Nitin, Beck, Juergen, Schnell, Oliver, Bello, Lorenzo, Hervey-Jumper, Shawn, Thon, Niklas, Grau, Stefan, Esquenazi, Yoshua, Rudà, Roberta, Chang, Susan, Berger, Mitchel, Cahill, Daniel, and Tonn, Joerg-Christian

Subjects
WHO 2021, contrast enhancement, extent of resection, glioblastoma, surgery, Humans, Glioblastoma, Retrospective Studies, Brain Neoplasms, Prognosis, Magnetic Resonance Imaging
Abstract

BACKGROUND: Resection of the contrast-enhancing (CE) tumor represents the standard of care in newly diagnosed glioblastoma. However, some tumors ultimately diagnosed as glioblastoma lack contrast enhancement and have a low-grade appearance on imaging (non-CE glioblastoma). We aimed to (a) volumetrically define the value of non-CE tumor resection in the absence of contrast enhancement, and to (b) delineate outcome differences between glioblastoma patients with and without contrast enhancement. METHODS: The RANO resect group retrospectively compiled a global, eight-center cohort of patients with newly diagnosed glioblastoma per WHO 2021 classification. The associations between postoperative tumor volumes and outcome were analyzed. Propensity score-matched analyses were constructed to compare glioblastomas with and without contrast enhancement. RESULTS: Among 1323 newly diagnosed IDH-wildtype glioblastomas, we identified 98 patients (7.4%) without contrast enhancement. In such patients, smaller postoperative tumor volumes were associated with more favorable outcome. There was an exponential increase in risk for death with larger residual non-CE tumor. Accordingly, extensive resection was associated with improved survival compared to lesion biopsy. These findings were retained on a multivariable analysis adjusting for demographic and clinical markers. Compared to CE glioblastoma, patients with non-CE glioblastoma had a more favorable clinical profile and superior outcome as confirmed in propensity score analyses by matching the patients with non-CE glioblastoma to patients with CE glioblastoma using a large set of clinical variables. CONCLUSIONS: The absence of contrast enhancement characterizes a less aggressive clinical phenotype of IDH-wildtype glioblastomas. Maximal resection of non-CE tumors has prognostic implications and translates into favorable outcome.

Published
2024

6. A framework for standardised tissue sampling and processing during resection of diffuse intracranial glioma: joint recommendations from four RANO groups

Author

Karschnia, Philipp, Smits, Marion, Reifenberger, Guido, Le Rhun, Emilie, Ellingson, Benjamin M, Galldiks, Norbert, Kim, Michelle M, Huse, Jason T, Schnell, Oliver, Harter, Patrick N, Mohme, Malte, Panel, Rater, Aldape, Kenneth, Baehring, Joachim M, Bello, Lorenzo, Brat, Daniel J, Cahill, Daniel P, Chung, Caroline, Colman, Howard, Dietrich, Jorg, Drummond, Katharine, Esquenazi, Yoshua, Gerstner, Elizabeth R, Furtner, Julia, Garibotto, Valentina, Kaufmann, Timothy J, Komori, Takashi, Kotecha, Rupesh, Liau, Linda M, Lupo, Janine M, Minniti, Giuseppe, Narita, Yoshitaka, Niyazi, Maximilian, Perry, Arie, Preusser, Matthias, Rudà, Roberta, Sanai, Nader, Schmidt, Nils-Ole, Steinbach, Joachim P, Thust, Stefanie C, Tolboom, Nelleke, van der Hoorn, Anouk, van der Vaart, Thijs, Verger, Antoine, Vik-Mo, Einar Osland, Watts, Colin, Westphal, Manfred, Wesseling, Pieter, Young, Jacob S, von Baumgarten, Louisa, Albert, Nathalie L, Huang, Raymond Y, Mehta, Minesh P, van den Bent, Martin, Weller, Michael, Vogelbaum, Michael A, Chang, Susan M, Berger, Mitchel S, and Tonn, Joerg-Christian

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Cancer, Brain Cancer, Brain Disorders, Rare Diseases, Neurosciences, Humans, Brain Neoplasms, Prospective Studies, Biological Specimen Banks, Neoplasm Recurrence, Local, Glioma, Expert Rater Panel, Oncology & Carcinogenesis, Oncology and carcinogenesis
Abstract

Surgical resection represents the standard of care for people with newly diagnosed diffuse gliomas, and the neuropathological and molecular profile of the resected tissue guides clinical management and forms the basis for research. The Response Assessment in Neuro-Oncology (RANO) consortium is an international, multidisciplinary effort that aims to standardise research practice in neuro-oncology. These recommendations represent a multidisciplinary consensus from the four RANO groups: RANO resect, RANO recurrent glioblastoma, RANO radiotherapy, and RANO/PET for a standardised workflow to achieve a representative tumour evaluation in a disease characterised by intratumoural heterogeneity, including recommendations on which tumour regions should be surgically sampled, how to define those regions on the basis of preoperative imaging, and the optimal sample volume. Practical recommendations for tissue sampling are given for people with low-grade and high-grade gliomas, as well as for people with newly diagnosed and recurrent disease. Sampling of liquid biopsies is also addressed. A standardised workflow for subsequent handling of the resected tissue is proposed to avoid information loss due to decreasing tissue quality or insufficient clinical information. The recommendations offer a framework for prospective biobanking studies.

Published
2023

7. Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group.

Author

Karschnia, Philipp, Dono, Antonio, Young, Jacob, Juenger, Stephanie, Teske, Nico, Häni, Levin, Sciortino, Tommaso, Mau, Christine, Bruno, Francesco, Nunez, Luis, Morshed, Ramin, Haddad, Alexander, Weller, Michael, van den Bent, Martin, Beck, Juergen, Hervey-Jumper, Shawn, Tandon, Nitin, Rudà, Roberta, Vogelbaum, Michael, Bello, Lorenzo, Schnell, Oliver, Grau, Stefan, Chang, Susan, Berger, Mitchel, Esquenazi, Yoshua, Tonn, Joerg-Christian, and Molinaro, Annette

Subjects
classification, extent of resection, glioblastoma recurrence, outcome, surgical re-resection, Humans, Glioblastoma, Prognosis, Retrospective Studies, Brain Neoplasms
Abstract

BACKGROUND: The value of re-resection in recurrent glioblastoma remains controversial as a randomized trial that specifies intentional incomplete resection cannot be justified ethically. Here, we aimed to (1) explore the prognostic role of extent of re-resection using the previously proposed Response Assessment in Neuro-Oncology (RANO) classification (based upon residual contrast-enhancing (CE) and non-CE tumor), and to (2) define factors consolidating the surgical effects on outcome. METHODS: The RANO resect group retrospectively compiled an 8-center cohort of patients with first recurrence from previously resected glioblastomas. The associations of re-resection and other clinical factors with outcome were analyzed. Propensity score-matched analyses were constructed to minimize confounding effects when comparing the different RANO classes. RESULTS: We studied 681 patients with first recurrence of Isocitrate Dehydrogenase (IDH) wild-type glioblastomas, including 310 patients who underwent re-resection. Re-resection was associated with prolonged survival even when stratifying for molecular and clinical confounders on multivariate analysis; ≤1 cm3 residual CE tumor was associated with longer survival than non-surgical management. Accordingly, maximal resection (class 2) had superior survival compared to submaximal resection (class 3). Administration of (radio-)chemotherapy in the absence of postoperative deficits augmented the survival associations of smaller residual CE tumors. Conversely, supramaximal resection of non-CE tumor (class 1) was not associated with prolonged survival but was frequently accompanied by postoperative deficits. The prognostic role of residual CE tumor was confirmed in propensity score analyses. CONCLUSIONS: The RANO resect classification serves to stratify patients with re-resection of glioblastoma. Complete resection according to RANO resect classes 1 and 2 is prognostic.

Published
2023

8. Diagnosis and management of complications from the treatment of primary central nervous system tumors in adults.

Author

Weller, Michael, Le Rhun, Emilie, Van den Bent, Martin, Chang, Susan M, Cloughesy, Timothy F, Goldbrunner, Roland, Hong, Yong-Kil, Jalali, Rakesh, Jenkinson, Michael D, Minniti, Giuseppe, Nagane, Motoo, Razis, Evangelia, Roth, Patrick, Rudà, Roberta, Tabatabai, Ghazaleh, Wen, Patrick Y, Short, Susan C, and Preusser, Matthias

Subjects
Humans, Lymphoma, Central Nervous System Neoplasms, Brain Neoplasms, Combined Modality Therapy, Quality of Life, Adult, adverse affects, dose, interruptions, prevention, reexposure, toxicity, Patient Safety, Neurosciences, Brain Disorders, Rare Diseases, Clinical Trials and Supportive Activities, Brain Cancer, Cancer, Clinical Research, 7.3 Management and decision making, Management of diseases and conditions, 7.1 Individual care needs, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Oncology and Carcinogenesis, Oncology & Carcinogenesis
Abstract

Central nervous system (CNS) tumor patients commonly undergo multimodality treatment in the course of their disease. Adverse effects and complications from these interventions have not been systematically studied, but pose significant challenges in clinical practice and impact function and quality of life, especially in the management of long-term brain tumor survivors. Here, the European Association of Neuro-Oncology (EANO) has developed recommendations to prevent, diagnose, and manage adverse effects and complications in the adult primary brain CNS tumor (except lymphomas) patient population with a specific focus on surgery, radiotherapy, and pharmacotherapy. Specifically, we also provide recommendations for dose adaptations, interruptions, and reexposure for pharmacotherapy that may serve as a reference for the management of standard of care in clinical trials. We also summarize which interventions are unnecessary, inactive or contraindicated. This consensus paper should serve as a reference for the conduct of standard therapy within and outside of clinical trials.

Published
2023

10. Prognostic validation of a new classification system for extent of resection in glioblastoma: A report of the RANO resect group

Author

Karschnia, Philipp, Young, Jacob S, Dono, Antonio, Häni, Levin, Sciortino, Tommaso, Bruno, Francesco, Juenger, Stephanie T, Teske, Nico, Morshed, Ramin A, Haddad, Alexander F, Zhang, Yalan, Stoecklein, Sophia, Weller, Michael, Vogelbaum, Michael A, Beck, Juergen, Tandon, Nitin, Hervey-Jumper, Shawn, Molinaro, Annette M, Rudà, Roberta, Bello, Lorenzo, Schnell, Oliver, Esquenazi, Yoshua, Ruge, Maximilian I, Grau, Stefan J, Berger, Mitchel S, Chang, Susan M, van den Bent, Martin, and Tonn, Joerg-Christian

Subjects
Brain Disorders, Rare Diseases, Brain Cancer, Cancer, Neurosciences, Humans, Prognosis, Glioblastoma, Retrospective Studies, Brain Neoplasms, Neurosurgical Procedures, Treatment Outcome, EOR, classification, glioblastoma, outcome, surgical resection, Oncology and Carcinogenesis, Oncology & Carcinogenesis
Abstract

BackgroundTerminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system was previously proposed based upon residual contrast-enhancing (CE) tumor. We aimed to (1) explore the prognostic utility of the classification system and (2) define how much removed non-CE tumor translates into a survival benefit.MethodsThe international RANO resect group retrospectively searched previously compiled databases from 7 neuro-oncological centers in the USA and Europe for patients with newly diagnosed glioblastoma per WHO 2021 classification. Clinical and volumetric information from pre- and postoperative MRI were collected.ResultsWe collected 1,008 patients with newly diagnosed IDHwt glioblastoma. 744 IDHwt glioblastomas were treated with radiochemotherapy per EORTC-26981/22981 (TMZ/RT→TMZ) following surgery. Among these homogenously treated patients, lower absolute residual tumor volumes (in cm3) were favorably associated with outcome: patients with "maximal CE resection" (class 2) had superior outcome compared to patients with "submaximal CE resection" (class 3) or "biopsy" (class 4). Extensive resection of non-CE tumor (≤5 cm3 residual non-CE tumor) was associated with better survival among patients with complete CE resection, thus defining class 1 ("supramaximal CE resection"). The prognostic value of the resection classes was retained on multivariate analysis when adjusting for molecular and clinical markers.ConclusionsThe proposed "RANO categories for extent of resection in glioblastoma" are highly prognostic and may serve for stratification within clinical trials. Removal of non-CE tumor beyond the CE tumor borders may translate into additional survival benefit, providing a rationale to explicitly denominate such "supramaximal CE resection."

Published
2023

14. Somatostatin analogues in treatment-refractory meningioma: a systematic review with meta-analysis of individual patient data

Author

Jensen, Lasse Rehné, Maier, Andrea Daniela, Lomstein, Atle, Graillon, Thomas, Hrachova, Maya, Bota, Daniela, Ruiz-Patiño, Alejandro, Arrieta, Oscar, Cardona, Andrés Felipe, Rudà, Roberta, Furtner, Julia, Roeckle, Ulrich, Clement, Paul, Preusser, Matthias, Scheie, David, Broholm, Helle, Kristensen, Bjarne Winther, Skjøth-Rasmussen, Jane, Ziebell, Morten, Munch, Tina Nørgaard, Fugleholm, Kåre, Walter, Martin A, Mathiesen, Tiit, and Mirian, Christian

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Brain Disorders, Cancer, Neurosciences, Clinical Research, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Everolimus, Humans, Meningeal Neoplasms, Meningioma, Prospective Studies, Receptors, Somatostatin, Somatostatin, Meta-analysis, Neuro-oncology, Treatment-refractory, Progressive, Neurology & Neurosurgery, Clinical sciences, Dentistry
Abstract

Treatment-refractory meningiomas have a dismal prognosis and limited treatment options. Meningiomas express high-densities of somatostatin receptors (SSTR), thus potentially susceptible to antitumorigenic effects of somatostatin analogues (SSA). Evidence for SSA in meningiomas is scarce, and it is unclear if published literature would either (1) support wider use of SSA, if (2) more evidence is desirable, or if (3) available evidence is sufficient to discard SSA. We addressed the need for more evidence with a systematic review and meta-analysis. We performed an individual patient data (IPD) meta-analysis. Main outcomes were toxicity, best radiological response, progression-free survival, and overall survival. We applied multivariable logistic regression models to estimate the effect of SSA on the probability of obtaining radiological disease control. The predictive performance was evaluated using area under the curve and Brier scores. We included 16 studies and compiled IPD from 8/9 of all previous cohorts. Quality of evidence was overall ranked "very low." Stable disease was reported in 58% of patients as best radiological response. Per 100 mg increase in total SSA dosage, the odds ratios for obtaining radiological disease control was 1.42 (1.11 to 1.81, P = 0.005) and 1.44 (1.00 to 2.08, P = 0.05) for patients treated with SSA as monodrug therapy vs SSA in combination with everolimus, respectively. Low quality of evidence impeded exact quantification of treatment efficacy, and the association between response and treatment may represent reverse causality. Yet, the SSA treatment was well tolerated, and beneficial effect cannot be disqualified. A prospective trial without bias from inconsistent study designs is warranted to assess SSA therapy for well-defined meningioma subgroups.

Published
2022

15. Liquid biopsy in gliomas: A RANO review and proposals for clinical applications.

Author

Soffietti, Riccardo, Bettegowda, Chetan, Mellinghoff, Ingo K, Warren, Katherine E, Ahluwalia, Manmeet S, De Groot, John F, Galanis, Evanthia, Gilbert, Mark R, Jaeckle, Kurt A, Le Rhun, Emilie, Rudà, Roberta, Seoane, Joan, Thon, Niklas, Umemura, Yoshie, Weller, Michael, van den Bent, Martin J, Vogelbaum, Michael A, Chang, Susan M, and Wen, Patrick Y

Subjects
Humans, Glioma, DNA, Neoplasm, Neoplastic Cells, Circulating, Biomarkers, Tumor, Liquid Biopsy, Circulating Tumor DNA, CSF, circulating tumor cells, ctDNA, extracellular vesicles, gliomas, Neurosciences, Brain Cancer, Cancer, Clinical Research, Rare Diseases, Brain Disorders, Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, Good Health and Well Being, Oncology and Carcinogenesis, Oncology & Carcinogenesis
Abstract

BackgroundThere is an extensive literature highlighting the utility of blood-based liquid biopsies in several extracranial tumors for diagnosis and monitoring.MethodsThe RANO (Response Assessment in Neuro-Oncology) group developed a multidisciplinary international Task Force to review the English literature on liquid biopsy in gliomas focusing on the most frequently used techniques, that is circulating tumor DNA, circulating tumor cells, and extracellular vesicles in blood and CSF.ResultsctDNA has a higher sensitivity and capacity to represent the spatial and temporal heterogeneity in comparison to circulating tumor cells. Exosomes have the advantages to cross an intact blood-brain barrier and carry also RNA, miRNA, and proteins. Several clinical applications of liquid biopsies are suggested: to establish a diagnosis when tissue is not available, monitor the residual disease after surgery, distinguish progression from pseudoprogression, and predict the outcome.ConclusionsThere is a need for standardization of biofluid collection, choice of an analyte, and detection strategies along with rigorous testing in future clinical trials to validate findings and enable entry into clinical practice.

Published
2022

19. PET-based response assessment criteria for diffuse gliomas (PET RANO 1.0): a report of the RANO group

Author

Albert, Nathalie L, Galldiks, Norbert, Ellingson, Benjamin M, van den Bent, Martin J, Chang, Susan M, Cicone, Francesco, de Groot, John, Koh, Eng-Siew, Law, Ian, Le Rhun, Emilie, Mair, Maximilian J, Minniti, Giuseppe, Rudà, Roberta, Scott, Andrew M, Short, Susan C, Smits, Marion, Suchorska, Bogdana, Tolboom, Nelleke, Traub-Weidinger, Tatjana, Tonn, Joerg-Christian, Verger, Antoine, Weller, Michael, Wen, Patrick Y, and Preusser, Matthias

Published
2024
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21. Surgical management of Glioma Grade 4: technical update from the neuro-oncology section of the Italian Society of Neurosurgery (SINch®): a systematic review

Author

Ius, Tamara, Sabatino, Giovanni, Panciani, Pier Paolo, Fontanella, Marco Maria, Rudà, Roberta, Castellano, Antonella, Barbagallo, Giuseppe Maria Vincenzo, Belotti, Francesco, Boccaletti, Riccardo, Catapano, Giuseppe, Costantino, Gabriele, Della Puppa, Alessandro, Di Meco, Francesco, Gagliardi, Filippo, Garbossa, Diego, Germanò, Antonino Francesco, Iacoangeli, Maurizio, Mortini, Pietro, Olivi, Alessandro, Pessina, Federico, Pignotti, Fabrizio, Pinna, Giampietro, Raco, Antonino, Sala, Francesco, Signorelli, Francesco, Sarubbo, Silvio, Skrap, Miran, Spena, Giannantonio, Somma, Teresa, Sturiale, Carmelo, Angileri, Filippo Flavio, and Esposito, Vincenzo

Published
2023
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22. A framework for standardised tissue sampling and processing during resection of diffuse intracranial glioma: joint recommendations from four RANO groups

Author

Aldape, Kenneth, Baehring, Joachim M., Bello, Lorenzo, Brat, Daniel J., Cahill, Daniel P., Chung, Caroline, Colman, Howard, Dietrich, Jorg, Drummond, Katharine, Esquenazi, Yoshua, Gerstner, Elizabeth R., Furtner, Julia, Garibotto, Valentina, Kaufmann, Timothy J., Komori, Takashi, Kotecha, Rupesh, Liau, Linda M., Lupo, Janine M., Minniti, Giuseppe, Narita, Yoshitaka, Niyazi, Maximilian, Perry, Arie, Preusser, Matthias, Rudà, Roberta, Sanai, Nader, Schmidt, Nils-Ole, Steinbach, Joachim P., Thust, Stefanie C., Tolboom, Nelleke, van der Hoorn, Anouk, van der Vaart, Thijs, Verger, Antoine, Vik-Mo, Einar Osland, Watts, Colin, Westphal, Manfred, Wesseling, Pieter, Young, Jacob S., Karschnia, Philipp, Smits, Marion, Reifenberger, Guido, Le Rhun, Emilie, Ellingson, Benjamin M, Galldiks, Norbert, Kim, Michelle M, Huse, Jason T, Schnell, Oliver, Harter, Patrick N, Mohme, Malte, von Baumgarten, Louisa, Albert, Nathalie L, Huang, Raymond Y, Mehta, Minesh P, van den Bent, Martin, Weller, Michael, Vogelbaum, Michael A, Chang, Susan M, Berger, Mitchel S, and Tonn, Joerg-Christian

Published
2023
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23. Long-term survival with IDH wildtype glioblastoma: first results from the ETERNITY Brain Tumor Funders’ Collaborative Consortium (EORTC 1419)

Author

Hertler, Caroline, Felsberg, Jörg, Gramatzki, Dorothee, Le Rhun, Emilie, Clarke, Jennifer, Soffietti, Riccardo, Wick, Wolfgang, Chinot, Olivier, Ducray, François, Roth, Patrick, McDonald, Kerrie, Hau, Peter, Hottinger, Andreas F., Reijneveld, Jaap, Schnell, Oliver, Marosi, Christine, Glantz, Michael, Darlix, Amélie, Lombardi, Giuseppe, Krex, Dietmar, Glas, Martin, Reardon, David A., van den Bent, Martin, Lefranc, Florence, Herrlinger, Ulrich, Razis, Evangelia, Carpentier, Antoine F., Phillips, Samuel, Rudà, Roberta, Wick, Antje, Tabouret, Emeline, Meyronet, David, Maurage, Claude-Alain, Rushing, Elisabeth, Rapkins, Robert, Bumes, Elisabeth, Hegi, Monika, Weyerbrock, Astrid, Aregawi, Dawit, Gonzalez-Gomez, Christian, Pellerino, Alessia, Klein, Martin, Preusser, Matthias, Bendszus, Martin, Golfinopoulos, Vassilis, von Deimling, Andreas, Gorlia, Thierry, Wen, Patrick Y., Reifenberger, Guido, and Weller, Michael

Published
2023
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26. Contributors

Author

Aghajani, Samira, primary, Ahmadi, Mazaher, additional, Akimitsu, Nobuyoshi, additional, Aldecoa, Iban, additional, Alves, José Luís, additional, Aran, Veronica, additional, Archilla, Ivan, additional, Arrieta, Oscar, additional, Arora, Geetanjali, additional, Bal, C.S., additional, Balaña, Carmen, additional, Balça-Silva, Joana, additional, Barbosa, Marcos, additional, Basso, João, additional, Behrooz, Amir Barzegar, additional, Bramini, Mattia, additional, Bruno, Francesco, additional, Cabral, Célia, additional, Cardona, Andrés F., additional, Carrato, Cristina, additional, Casalino, Simona, additional, Cascão, Rita, additional, Castagnola, Valentina, additional, Castañer Llanes, Sara, additional, Castelo-Branco, Miguel, additional, Clark, Courtney, additional, Coelho-Santos, Vanessa, additional, Cook, Alexander B., additional, Costa, Bárbara, additional, Costa, Bruno M., additional, Costa, Gustavo, additional, Costabile, Gabriella, additional, Cova, Tânia F.G.G., additional, Dabiri, Seyed Mohammad Hossein, additional, Daher, Ahmad, additional, Delgado, Jéssica, additional, Díaz-Lanza, Ana María, additional, Domenech, Marta, additional, Domínguez-Martín, Eva María, additional, Dubois, Luiz Gustavo, additional, Duskey, Jason T., additional, Efferth, Thomas, additional, Faria, Claudia C., additional, Fortuna, Ana, additional, Garcia-Robledo, Juan Esteban, additional, Ghavami, Saeid, additional, Gimeno, Alfredo, additional, Gomes, Célia M.F., additional, Guerreiro, Joana F., additional, Halder, Ankit, additional, Hernandez, Ainhoa, additional, Hernández Santana, Electra Eduina, additional, Kesari, Santosh, additional, Lopez-Rueda, Antonio, additional, Madrakian, Tayyebeh, additional, Magalhães, Mariana, additional, Manadas, Bruno, additional, Martins, Cláudia, additional, Matias, Diana, additional, Mendes, Filipa, additional, Mendes, Maria, additional, Miller, Donald W., additional, Moran, Teresa, additional, Moreira, Ana, additional, Moreno, Montse, additional, Moschetta, Matteo, additional, Mosquera, Andrés, additional, Moura-Neto, Vivaldo, additional, Mukherjee, Arani, additional, Nunes, Sandra C.C., additional, Oleaga, Laura, additional, Ordoñez, Camila, additional, Pacheco, Catarina, additional, Pais, Alberto A.C.C., additional, Paulo, António, additional, Pellerino, Alessia, additional, Pereira, Mariana, additional, Pineda, Estela, additional, Pinto, Catarina I.G., additional, Prakash, Prasoon, additional, Pronello, Edoardo, additional, Puig, Josep, additional, Ribalta, Teresa, additional, Rijo, Patrícia, additional, Rojas, Katerina, additional, Rudà, Roberta, additional, Saba, Luca, additional, Sarmento, Bruno, additional, Schlich, Michele, additional, Sengupta, Shreoshi, additional, Silva, Fernando, additional, Silva, Francisco, additional, Somasundaram, Kumaravel, additional, Sousa, João, additional, Srivastava, Sanjeeva, additional, Tosi, Giovanni, additional, Trevisani, Martina, additional, Vale, Nuno, additional, Varela, Carla, additional, Verma, Ayushi, additional, Vieito, Maria, additional, Vitorino, Carla, additional, Vitorino, Rui, additional, Walsh, Tavia, additional, and Yathindranath, Vinith, additional

Published
2023
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28. Liquid biopsy in central nervous system metastases: a RANO review and proposals for clinical applications.

Author

Boire, Adrienne, Brandsma, Dieta, Brastianos, Priscilla, Le Rhun, Emilie, Ahluwalia, Manmeet, Junck, Larry, Glantz, Michael, Groves, Morris, Lee, Eudocia, Lin, Nancy, Raizer, Jeffrey, Rudà, Roberta, Weller, Michael, Van den Bent, Martin, Vogelbaum, Michael, Chang, Susan, Wen, Patrick, and Soffietti, Riccardo

Subjects
CNS metastases, circulating tumor cells, clinical implications, ctDNA, liquid biopsy, Central Nervous System Neoplasms, Circulating Tumor DNA, Clinical Decision-Making, Humans, Liquid Biopsy, Neoplasm Metastasis, Neoplastic Cells, Circulating, Prognosis
Abstract

Liquid biopsies collect and analyze tumor components in body fluids, and there is an increasing interest in the investigation of liquid biopsies as a surrogate for tumor tissue in the management of both primary and secondary brain tumors. Herein we critically review available literature on spinal fluid and plasma circulating tumor cells (CTCs) and cell-free tumor (ctDNA) for diagnosis and monitoring of leptomeningeal and parenchymal brain metastases. We discuss technical issues and propose several potential applications of liquid biopsies in different clinical settings (ie, for initial diagnosis, for assessment during treatment, and for guidance of treatment decisions). Last, ongoing clinical studies on CNS metastases that include liquid biopsies are summarized, and recommendations for future clinical studies are provided.

Published
2019

30. Financial challenges of being on long-term, high-cost medications.

Author

Elshiekh, Cleopatra, Rudà, Roberta, Cliff, Edward R Scheffer, Gany, Francesca, and Budhu, Joshua A

Subjects
*ECONOMIC impact, *QUALITY of life, *PATIENT compliance, *SOCIAL determinants of health, *ISOCITRATE dehydrogenase, *DRUG prices
Abstract

The isocitrate dehydrogenase (IDH) inhibitor, vorasidenib, may offer a promising new treatment option for patients with IDH-mutant gliomas. However, the indefinite nature of this targeted therapy raises significant financial concerns. High costs of targeted cancer therapies, often exceeding $150 000 annually, contribute to financial toxicity, characterized by medical debt, income loss, and psychological stress, and place stress on health systems. This review analyzes the drug approval and pricing mechanisms in various countries and their impact on healthcare costs and patient access, focusing specifically on the impacts in neuro-oncology. The United States employs a market-driven approach resulting in higher drug prices, while most countries, such as the United Kingdom, Germany, France, Italy, Japan, South Africa, and Brazil, use negotiated pricing and health technology assessment to manage costs. The financial burden of expensive medications affects patient adherence and quality of life, with many cancer patients facing substantial out-of-pocket expenses and potential treatment abandonment, and many more unable to access these drugs altogether. Vorasidenib's introduction, while potentially improving patient outcomes, may exacerbate financial toxicity unless mitigated by patient access programs and cost-management strategies. As neuro-oncology treatment paradigms evolve, understanding the economic implications of new therapies is essential to ensure equitable access and optimize patient care. [ABSTRACT FROM AUTHOR]

Published
2025
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31. Central nervous system tumors in adolescents and young adults: A Society for Neuro-Oncology Consensus Review on diagnosis, management, and future directions.

Author

Lim-Fat, Mary Jane, Bennett, Julie, Ostrom, Quinn, Touat, Mehdi, Franceschi, Enrico, Schulte, Jessica, Bindra, Ranjit S, Fangusaro, Jason, Dhall, Girish, Nicholson, James, Jackson, Sadhana, Davidson, Tom Belle, Calaminus, Gabriele, Robinson, Giles, Whittle, James R, Hau, Peter, Ramaswamy, Vijay, Pajtler, Kristian W, Rudà, Roberta, and Foreman, Nicholas K

Published
2025
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32. Characterization and management of neurological adverse events during immune-checkpoint inhibitors treatment: an Italian multicentric experience

Author

Diamanti, Luca, Picca, Alberto, Bini, Paola, Gastaldi, Matteo, Alfonsi, Enrico, Pichiecchio, Anna, Rota, Eugenia, Rudà, Roberta, Bruno, Francesco, Villani, Veronica, Galiè, Edvina, Vogrig, Alberto, Valente, Mariarosaria, Zoccarato, Marco, Poretto, Valentina, Giometto, Bruno, Cimminiello, Carolina, Del Vecchio, Michele, and Marchioni, Enrico

Published
2022
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33. Prevention of Brain Metastases: A New Frontier

Author

Pellerino, Alessia, primary, Davidson, Tara Marie, additional, Bellur, Shreyas S., additional, Ahluwalia, Manmeet S., additional, Tawbi, Hussein, additional, Rudà, Roberta, additional, and Soffietti, Riccardo, additional

Published
2024
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35. Adjuvant and concurrent temozolomide for 1p/19q non-co-deleted anaplastic glioma (CATNON; EORTC study 26053-22054): second interim analysis of a randomised, open-label, phase 3 study

Author

van den Bent, Martin J, Tesileanu, C Mircea S, Wick, Wolfgang, Sanson, Marc, Brandes, Alba Ariela, Clement, Paul M, Erridge, Sarah, Vogelbaum, Michael A, Nowak, Anna K, Baurain, Jean Français, Mason, Warren P, Wheeler, Helen, Chinot, Olivier L, Gill, Sanjeev, Griffin, Matthew, Rogers, Leland, Taal, Walter, Rudà, Roberta, Weller, Michael, McBain, Catherine, Reijneveld, Jaap, Enting, Roelien H, Caparrotti, Francesca, Lesimple, Thierry, Clenton, Susan, Gijtenbeek, Anja, Lim, Elizabeth, Herrlinger, Ulrich, Hau, Peter, Dhermain, Frederic, de Heer, Iris, Aldape, Kenneth, Jenkins, Robert B, Dubbink, Hendrikus Jan, Kros, Johan M, Wesseling, Pieter, Nuyens, Sarah, Golfinopoulos, Vassilis, Gorlia, Thierry, French, Pim, and Baumert, Brigitta G

Published
2021
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37. Epilepsy in CNS Metastases

Author

Rudà, Roberta, Pellerino, Alessia, Soffietti, Riccardo, Ahluwalia, Manmeet, editor, Metellus, Philippe, editor, and Soffietti, Riccardo, editor

Published
2020
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39. Non-IDH1-R132H IDH1/2 mutations are associated with increased DNA methylation and improved survival in astrocytomas, compared to IDH1-R132H mutations

Author

Tesileanu, C. Mircea S., Vallentgoed, Wies R., Sanson, Marc, Taal, Walter, Clement, Paul M., Wick, Wolfgang, Brandes, Alba Ariela, Baurain, Jean Francais, Chinot, Olivier L., Wheeler, Helen, Gill, Sanjeev, Griffin, Matthew, Rogers, Leland, Rudà, Roberta, Weller, Michael, McBain, Catherine, Reijneveld, Jaap, Enting, Roelien H., Caparrotti, Francesca, Lesimple, Thierry, Clenton, Susan, Gijtenbeek, Anja, Lim, Elizabeth, de Vos, Filip, Mulholland, Paul J., Taphoorn, Martin J. B., de Heer, Iris, Hoogstrate, Youri, de Wit, Maurice, Boggiani, Lorenzo, Venneker, Sanne, Oosting, Jan, Bovée, Judith V. M. G., Erridge, Sara, Vogelbaum, Michael A., Nowak, Anna K., Mason, Warren P., Kros, Johan M., Wesseling, Pieter, Aldape, Ken, Jenkins, Robert B., Dubbink, Hendrikus J., Baumert, Brigitta, Golfinopoulos, Vassilis, Gorlia, Thierry, van den Bent, Martin, and French, Pim J.

Published
2021
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41. Liquid biopsy for improving diagnosis and monitoring of CNS lymphomas: a RANO review

Author

Nayak, Lakshmi, primary, Bettegowda, Chetan, additional, Scherer, Florian, additional, Galldiks, Norbert, additional, Ahluwalia, Manmeet, additional, Baraniskin, Alexander, additional, von Baumgarten, Louisa, additional, Bromberg, Jacoline E C, additional, Ferreri, Andrés J M, additional, Grommes, Christian, additional, Hoang-Xuan, Khê, additional, Kühn, Julia, additional, Rubenstein, James L, additional, Rudà, Roberta, additional, Weller, Michael, additional, Chang, Susan M, additional, van den Bent, Martin J, additional, Wen, Patrick Y, additional, and Soffietti, Riccardo, additional

Published
2024
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42. Prognostic Evaluation of Surgical Re-Resection for Recurrent Glioblastoma Using the Novel RANO Classification for Extent of Resection by The RANO Resect Group

Author

Karschnia, Philipp, primary, Dono Ostorga, Antonio Gabriel, additional, Young, Jacob, additional, Jünger, Stephanie T., additional, Teske, Nico, additional, Häni, Levin, additional, Sciortino, Tommaso, additional, Mau, Christine Y., additional, Bruno, Francesco, additional, Nunez, Luis C., additional, Weller, Michael, additional, van den Bent, Martin, additional, Beck, Juergen, additional, Hervey-Jumper, Shawn L., additional, Molinaro, Annette, additional, Tandon, Nitin, additional, Rudà, Roberta, additional, Vogelbaum, Michael A., additional, Bello, Lorenzo, additional, Schnell, Oliver, additional, Grau, Stefan J., additional, Chang, Susan M., additional, Berger, Mitchel S., additional, Esquenazi, Yoshua, additional, and Tonn, Joerg-Christian, additional

Published
2024
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43. Inequalities in access to neuro-oncology supportive care and rehabilitation: A survey of healthcare professionals’ perspectives

Author

Boele, Florien, primary, Rosenlund, Lena, additional, Nordentoft, Sara, additional, Melhuish, Sara, additional, Nicklin, Emma, additional, Rydén, Isabelle, additional, Williamson, Aoife, additional, Donders-Kamphuis, Marike, additional, Preusser, Matthias, additional, Le Rhun, Emilie, additional, Kiesel, Barbara, additional, Minniti, Giuseppe, additional, Furtner, Julia, additional, Dirven, Linda, additional, Taphoorn, Martin, additional, Galldiks, Norbert, additional, Rudà, Roberta, additional, Chalmers, Anthony, additional, Short, Susan C, additional, and Piil, Karin, additional

Published
2024
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44. EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood

Author

Weller, Michael, van den Bent, Martin, Preusser, Matthias, Le Rhun, Emilie, Tonn, Jörg C., Minniti, Giuseppe, Bendszus, Martin, Balana, Carmen, Chinot, Olivier, Dirven, Linda, French, Pim, Hegi, Monika E., Jakola, Asgeir S., Platten, Michael, Roth, Patrick, Rudà, Roberta, Short, Susan, Smits, Marion, Taphoorn, Martin J. B., von Deimling, Andreas, Westphal, Manfred, Soffietti, Riccardo, Reifenberger, Guido, and Wick, Wolfgang

Published
2021
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45. Medulloblastoma of the adult: results from a multicenter retrospective study by AINO (Italian Association of Neuro-Oncology) and SIN (Italian Society of Neurology)

Author

Gaviani, Paola, Simonetti, Giorgia, Rudà, Roberta, Franchino, Federica, Lombardi, Giuseppe, Possanzini, Marco, Squintu, Sara, Villani, Veronica, Teriaca, Mariaausilia, Cavallieri, Francesco, Caffo, Maria, Salmaggi, Andrea, Bianco, Andrea, Anghileri, Elena, Farinotti, Mariangela, Tramacere, Irene, and Silvani, Antonio

Published
2021
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46. Leptomeningeal Metastases from Solid Tumors : A Society for Neuro-Oncology and American Society of Clinical Oncology Consensus Review on Clinical Management and Future Directions

Author

Wilcox, Jessica A; https://orcid.org/0000-0002-2919-1360, Chukwueke, Ugonma N; https://orcid.org/0000-0003-0598-9535, Ahn, Myung-Ju, Aizer, Ayal A; https://orcid.org/0000-0002-8941-188X, Bale, Tejus A; https://orcid.org/0000-0003-3641-9287, Brandsma, Dieta; https://orcid.org/0000-0001-7998-9904, Brastianos, Priscilla K; https://orcid.org/0000-0003-4470-8425, Chang, Susan; https://orcid.org/0000-0003-3521-364X, Daras, Mariza; https://orcid.org/0000-0002-2613-1709, Forsyth, Peter; https://orcid.org/0000-0002-3756-8594, Garzia, Livia; https://orcid.org/0000-0002-5016-0753, Glantz, Michael; https://orcid.org/0000-0003-4877-5094, Oliva, Isabella C Glitza; https://orcid.org/0000-0002-4530-7765, Kumthekar, Priya; https://orcid.org/0000-0001-5923-0677, Le Rhun, Emilie; https://orcid.org/0000-0002-9408-3278, Nagpal, Seema; https://orcid.org/0000-0002-0289-2319, O’Brien, Barbara, Pentsova, Elena; https://orcid.org/0000-0001-5854-0251, Lee, Eudocia Quant; https://orcid.org/0000-0003-3355-5179, Remsik, Jan; https://orcid.org/0000-0002-3228-2896, Rudà, Roberta; https://orcid.org/0000-0001-9134-1537, Smalley, Inna; https://orcid.org/0000-0002-6796-9145, Taylor, Michael D, Weller, Michael; https://orcid.org/0000-0002-1748-174X, Wefel, Jeffrey; https://orcid.org/0000-0003-3584-023X, Yang, Jonathan T; https://orcid.org/0000-0001-9375-7384, Young, Robert J; https://orcid.org/0000-0001-7003-3017, Wen, Patrick Y; https://orcid.org/0000-0002-0774-7700, Boire, Adrienne A; https://orcid.org/0000-0002-9029-1248, Wilcox, Jessica A; https://orcid.org/0000-0002-2919-1360, Chukwueke, Ugonma N; https://orcid.org/0000-0003-0598-9535, Ahn, Myung-Ju, Aizer, Ayal A; https://orcid.org/0000-0002-8941-188X, Bale, Tejus A; https://orcid.org/0000-0003-3641-9287, Brandsma, Dieta; https://orcid.org/0000-0001-7998-9904, Brastianos, Priscilla K; https://orcid.org/0000-0003-4470-8425, Chang, Susan; https://orcid.org/0000-0003-3521-364X, Daras, Mariza; https://orcid.org/0000-0002-2613-1709, Forsyth, Peter; https://orcid.org/0000-0002-3756-8594, Garzia, Livia; https://orcid.org/0000-0002-5016-0753, Glantz, Michael; https://orcid.org/0000-0003-4877-5094, Oliva, Isabella C Glitza; https://orcid.org/0000-0002-4530-7765, Kumthekar, Priya; https://orcid.org/0000-0001-5923-0677, Le Rhun, Emilie; https://orcid.org/0000-0002-9408-3278, Nagpal, Seema; https://orcid.org/0000-0002-0289-2319, O’Brien, Barbara, Pentsova, Elena; https://orcid.org/0000-0001-5854-0251, Lee, Eudocia Quant; https://orcid.org/0000-0003-3355-5179, Remsik, Jan; https://orcid.org/0000-0002-3228-2896, Rudà, Roberta; https://orcid.org/0000-0001-9134-1537, Smalley, Inna; https://orcid.org/0000-0002-6796-9145, Taylor, Michael D, Weller, Michael; https://orcid.org/0000-0002-1748-174X, Wefel, Jeffrey; https://orcid.org/0000-0003-3584-023X, Yang, Jonathan T; https://orcid.org/0000-0001-9375-7384, Young, Robert J; https://orcid.org/0000-0001-7003-3017, Wen, Patrick Y; https://orcid.org/0000-0002-0774-7700, and Boire, Adrienne A; https://orcid.org/0000-0002-9029-1248

Abstract

Leptomeningeal metastases (LM) are increasingly becoming recognized as a treatable, yet generally incurable, complication of advanced cancer. As modern cancer therapeutics have prolonged the lives of patients with metastatic cancer, specifically in patients with parenchymal brain metastases, treatment options, and clinical research protocols for patients with LM from solid tumors have similarly evolved to improve survival within specific populations. Recent expansions in clinical investigation, early diagnosis, and drug development have given rise to new unanswered questions. These include leptomeningeal metastasis biology and preferred animal modeling, epidemiology in the modern cancer population, ensuring validation and accessibility of newer leptomeningeal metastasis diagnostics, best clinical practices with multimodality treatment options, clinical trial design and standardization of response assessments, and avenues worthy of further research. An international group of multi-disciplinary experts in the research and management of LM, supported by the Society for Neuro-Oncology and American Society of Clinical Oncology, were assembled to reach a consensus opinion on these pressing topics and provide a roadmap for future directions. Our hope is that these recommendations will accelerate collaboration and progress in the field of LM and serve as a platform for further discussion and patient advocacy.

Published
2024

47. PET-based response assessment criteria for diffuse gliomas (PET RANO 1.0): a report of the RANO group

Author

MS Radiologie, Brain, Cancer, Albert, Nathalie L, Galldiks, Norbert, Ellingson, Benjamin M, van den Bent, Martin J, Chang, Susan M, Cicone, Francesco, de Groot, John, Koh, Eng-Siew, Law, Ian, Le Rhun, Emilie, Mair, Maximilian J, Minniti, Giuseppe, Rudà, Roberta, Scott, Andrew M, Short, Susan C, Smits, Marion, Suchorska, Bogdana, Tolboom, Nelleke, Traub-Weidinger, Tatjana, Tonn, Joerg-Christian, Verger, Antoine, Weller, Michael, Wen, Patrick Y, Preusser, Matthias, MS Radiologie, Brain, Cancer, Albert, Nathalie L, Galldiks, Norbert, Ellingson, Benjamin M, van den Bent, Martin J, Chang, Susan M, Cicone, Francesco, de Groot, John, Koh, Eng-Siew, Law, Ian, Le Rhun, Emilie, Mair, Maximilian J, Minniti, Giuseppe, Rudà, Roberta, Scott, Andrew M, Short, Susan C, Smits, Marion, Suchorska, Bogdana, Tolboom, Nelleke, Traub-Weidinger, Tatjana, Tonn, Joerg-Christian, Verger, Antoine, Weller, Michael, Wen, Patrick Y, and Preusser, Matthias

Published
2024

48. Liquid biopsy for improving diagnosis and monitoring of CNS lymphomas:A RANO review

Author

Nayak, Lakshmi, Bettegowda, Chetan, Scherer, Florian, Galldiks, Norbert, Ahluwalia, Manmeet, Baraniskin, Alexander, von Baumgarten, Louisa, Bromberg, Jacoline E.C., Ferreri, Andrés J.M., Grommes, Christian, Hoang-Xuan, Khê, Kühn, Julia, Rubenstein, James L., Rudà, Roberta, Weller, Michael, Chang, Susan M., van den Bent, Martin J., Wen, Patrick Y., Soffietti, Riccardo, Nayak, Lakshmi, Bettegowda, Chetan, Scherer, Florian, Galldiks, Norbert, Ahluwalia, Manmeet, Baraniskin, Alexander, von Baumgarten, Louisa, Bromberg, Jacoline E.C., Ferreri, Andrés J.M., Grommes, Christian, Hoang-Xuan, Khê, Kühn, Julia, Rubenstein, James L., Rudà, Roberta, Weller, Michael, Chang, Susan M., van den Bent, Martin J., Wen, Patrick Y., and Soffietti, Riccardo

Abstract

BACKGROUND: The utility of liquid biopsies is well documented in several extracranial and intracranial (brain/leptomeningeal metastases, gliomas) tumors. METHODS: The RANO (Response Assessment in Neuro-Oncology) group has set up a multidisciplinary Task Force to critically review the role of blood and cerebrospinal fluid (CSF)-liquid biopsy in CNS lymphomas, with a main focus on primary central nervous system lymphomas (PCNSL). RESULTS: Several clinical applications are suggested: diagnosis of PCNSL in critical settings (elderly or frail patients, deep locations, and steroid responsiveness), definition of minimal residual disease, early indication of tumor response or relapse following treatments, and prediction of outcome. CONCLUSIONS: Thus far, no clinically validated circulating biomarkers for managing both primary and secondary CNS lymphomas exist. There is need of standardization of biofluid collection, choice of analytes, and type of technique to perform the molecular analysis. The various assays should be evaluated through well-organized central testing within clinical trials.

Published
2024

49. Challenges, limitations, and pitfalls of PET and advanced MRI in patients with brain tumors:A report of the PET/RANO group

Author

Galldiks, Norbert, Kaufmann, Timothy J., Vollmuth, Philipp, Lohmann, Philipp, Smits, Marion, Veronesi, Michael C., Langen, Karl Josef, Rudà, Roberta, Albert, Nathalie L., Hattingen, Elke, Law, Ian, Hutterer, Markus, Soffietti, Riccardo, Vogelbaum, Michael A., Wen, Patrick Y., Weller, Michael, Tonn, Joerg Christian, Galldiks, Norbert, Kaufmann, Timothy J., Vollmuth, Philipp, Lohmann, Philipp, Smits, Marion, Veronesi, Michael C., Langen, Karl Josef, Rudà, Roberta, Albert, Nathalie L., Hattingen, Elke, Law, Ian, Hutterer, Markus, Soffietti, Riccardo, Vogelbaum, Michael A., Wen, Patrick Y., Weller, Michael, and Tonn, Joerg Christian

Abstract

Brain tumor diagnostics have significantly evolved with the use of positron emission tomography (PET) and advanced magnetic resonance imaging (MRI) techniques. In addition to anatomical MRI, these modalities may provide valuable information for several clinical applications such as differential diagnosis, delineation of tumor extent, prognostication, differentiation between tumor relapse and treatment-related changes, and the evaluation of response to anticancer therapy. In particular, joint recommendations of the Response Assessment in Neuro-Oncology (RANO) Group, the European Association of Neuro-oncology, and major European and American Nuclear Medicine societies highlighted that the additional clinical value of radiolabeled amino acids compared to anatomical MRI alone is outstanding and that its widespread clinical use should be supported. For advanced MRI and its steadily increasing use in clinical practice, the Standardization Subcommittee of the Jumpstarting Brain Tumor Drug Development Coalition provided more recently an updated acquisition protocol for the widely used dynamic susceptibility contrast perfusion MRI. Besides amino acid PET and perfusion MRI, other PET tracers and advanced MRI techniques (e.g. MR spectroscopy) are of considerable clinical interest and are increasingly integrated into everyday clinical practice. Nevertheless, these modalities have shortcomings which should be considered in clinical routine. This comprehensive review provides an overview of potential challenges, limitations, and pitfalls associated with PET imaging and advanced MRI techniques in patients with gliomas or brain metastases. Despite these issues, PET imaging and advanced MRI techniques continue to play an indispensable role in brain tumor management. Acknowledging and mitigating these challenges through interdisciplinary collaboration, standardized protocols, and continuous innovation will further enhance the utility of these modalities in guiding optimal patient

Published
2024

50. A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas

Author

Basile, Michele, Valentini, Ilaria, Attanasio, Roberto, Cozzi, Renato, Persichetti, Agnese, Samperi, Irene, Scoppola, Alessandro, Auriemma, Renata Simona, Menis, Ernesto De, Esposito, Felice, Ferrante, Emanuele, Iatì, Giuseppe, Mazzatenta, Diego, Maurizio Poggi, Rudà, Roberta, Tortora, Fabio, Cruciani, Fabio, Mitrova, Zuzana, Saulle, Rosella, Vecchi, Simona, Cappabianca, Paolo, Paoletta, Agostino, Bozzao, Alessandro, Caputo, Marco, Doglietto, Francesco, Ferraù, Francesco, Lania, Andrea Gerardo, Laureti, Stefano, Lello, Stefano, Locatelli, Davide, Maffei, Pietro, Minniti, Giuseppe, Peri, Alessandro, Ruini, Chiara, Settanni, Fabio, Silvani, Antonio, Veronese, Nadia, Grimaldi, Franco, Papini, Enrico, Cicchetti, Americo, Basile, Michele, Valentini, Ilaria, Attanasio, Roberto, Cozzi, Renato, Persichetti, Agnese, Samperi, Irene, Scoppola, Alessandro, Auriemma, Renata Simona, Menis, Ernesto De, Esposito, Felice, Ferrante, Emanuele, Iatì, Giuseppe, Mazzatenta, Diego, Maurizio Poggi, Rudà, Roberta, Tortora, Fabio, Cruciani, Fabio, Mitrova, Zuzana, Saulle, Rosella, Vecchi, Simona, Cappabianca, Paolo, Paoletta, Agostino, Bozzao, Alessandro, Caputo, Marco, Doglietto, Francesco, Ferraù, Francesco, Lania, Andrea Gerardo, Laureti, Stefano, Lello, Stefano, Locatelli, Davide, Maffei, Pietro, Minniti, Giuseppe, Peri, Alessandro, Ruini, Chiara, Settanni, Fabio, Silvani, Antonio, Veronese, Nadia, Grimaldi, Franco, Papini, Enrico, and Cicchetti, Americo

Abstract

Background: Prolactinoma, the most common pituitary adenoma, is usually treated with dopamine agonist (DA) therapy like cabergoline. Surgery is second-line therapy, and radiotherapy is used if surgical treatment fails or in relapsing macroprolactinoma. Objective: This study aimed to provide economic evidence for the management of prolactinoma in Italy, using a cost-of-illness and cost-utility analysis that considered various treatment options, including cabergoline, bromocriptine, temozolomide, radiation therapy, and surgical strategies. Methods: The researchers conducted a systematic literature review for each research question on scientific databases and surveyed a panel of experts for each therapeutic procedure’s specific drivers that contributed to its total cost. Results: The average cost of the first year of treatment was €2,558.91 and €3,287.40 for subjects with microprolactinoma and macroprolactinoma, respectively. Follow-up costs from the second to the fifth year after initial treatment were €798.13 and €1,084.59 per year in both groups. Cabergoline had an adequate cost-utility profile, with an incremental cost-effectiveness ratio (ICER) of €3,201.15 compared to bromocriptine, based on a willingness-to-pay of €40,000 per quality-adjusted life year (QALY) in the reference economy. Endoscopic surgery was more cost-effective than cabergoline, with an ICER of €44,846.64. Considering a willingness-to-pay of €40,000/QALY, the baseline findings show cabergoline to have high cost utility and endoscopic surgery just a tad above that. Conclusions: Due to the favorable cost-utility profile and safety of surgical treatment, pituitary surgery should be considered more frequently as the initial therapeutic approach. This management choice could lead to better outcomes and an appropriate allocation of healthcare resources.

Published
2024

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